Mind your modifiers: As modifier 25 audits pick up, key in on internal review, provider education

Why This Topic Matters

The topic is relevant to organizations preparing for greater scrutiny of same-day services, including the possible operational and financial effects of audits and the role of ongoing compliance oversight.

Article Sections

1. Audit attention and same-day services

   Introduces the planned audit and discusses same-day evaluation and management services in the context of minor procedures and claims review.

2. Work must go ‘above and beyond’

   Reviews outpatient procedure settings, the global surgical package, and the broader context for evaluation and management services performed on the same day.

3. Clinical scenarios and procedure considerations

   Covers clinical scenarios discussed in the article and considerations involving minor procedures and global periods.

4. Practice oversight and audit exposure

   Addresses potential operational, financial, and compliance effects of audits on practices and health systems.

5. Internal review and provider education

   Discusses internal compliance activities and provider education in connection with increased audit attention.