DecisionHealth, DecisionHealth - 2026 Issue 7 (July)

Think like an auditor to defend modifier 25 reporting

Federal and private health care carriers haven’t relaxed their scrutiny of the modifier, even though nearly 21 years have passed since the release of Use of Modifier 25, a report from the HHS Office of Inspector General (OIG) that revealed that in one year, 35% of claims submitted with the modifier did not meet Medicare requirements.

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