tci Medicare Compliance & Reimbursement - 2016 Issue 21

Benchmarking: Compare Your Physician Assistant's Modifier 25 Billing with Other PAs

Take a look at a recent CBR on physician assistants, E/M visits, and modifier 25. Benchmarking has become a popular revenue tool for providers to compare their billing patterns against those of their medical cohorts. Sifting through the data to see where you rank can help your practice figure out the ups and downs of billing trends, revenue, and more importantly, your level of patient care. Background. The OIG took a random sampling of 450 claims out of 29 million in 2002 and discovered that modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or...

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