tci Medicare Compliance & Reimbursement - 2010 Issue 9
Compliance: OIG Revisits Recommendation to Review Modifier 59 Claims
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Article Overview
This article discusses an OIG compliance report, prior findings related to modifier 59 claims, and CMS activity tied to incident-to billing policies. It is aimed at coding, billing, and compliance professionals who monitor audit risk, documentation practices, and payer policy updates. The article provides a high-level discussion of oversight concerns, system review recommendations, and policy clarification efforts without serving as a coding manual.
Why This Topic Matters
It helps readers understand where government oversight has focused attention in billing compliance and why modifier use and incident-to policy updates continue to matter for audits and internal review.
What You Will Learn
- How OIG compliance reports can influence billing oversight priorities
- Why modifier 59 and related claim review have remained a compliance focus
- What general policy areas CMS was revising in response to OIG attention
- How compliance monitoring can affect practices and carriers
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Revenue cycle professionals
- Auditors
Modifiers Discussed
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