tci Medicare Compliance & Reimbursement - 2010 Issue 9

Compliance: OIG Revisits Recommendation to Review Modifier 59 Claims

Modifier 59 misuse led to millions in overpayments. When the OIG talks, not everyone listens, a new report indicates. The OIG makes hundreds of recommendations each year, advising practices and carriers to tighten up documentation, correct their modifier use, or implement additional programs. On March 11, the OIG released its 202-page "Compendium of Unimplemented OIG Recommendations," which revealed that many OIG suggestions have been ignored. Case in point: In 2003, the OIG found a 40 percent error rate on claims that contained modifier 59 when used to separate Correct Coding Initiative (CCI) edits, resulting in Medicare paying $59...

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