Mind your modifiers: Create a plan to defend modifier 25 claims ahead of new Cigna policy

Why This Topic Matters

Modifier 25 claims are a common audit and denial focus, so practices need to understand payer requirements, documentation expectations, and internal processes that support compliant billing and reimbursement.

Article Sections

1. Payer scrutiny and policy updates

   This section summarizes changing payer attention to claims reporting and identifies insurers referenced in the article. It frames why practices should monitor policy updates and documentation requests.

2. Train with the descriptor and the cross-out test

   This section discusses training themes for providers and coding staff, including documentation review concepts used to evaluate whether services stand alone. It emphasizes communication and education within the practice.

3. Create a plan to defend your claims

   This section outlines practice-wide preparation for denials, prepayment review, and documentation requests. It describes the roles of providers, coders, and accounts receivable staff in managing claims issues.

4. Resources

   This section lists supporting references and external policy resources related to the article topic. It serves as a reference point for readers seeking additional background.