Fact Finder: Keep Your Claims Running Smoothly

Why This Topic Matters

Misunderstanding payer policies can create denied claims, payment errors, and compliance risk. This article helps readers recognize where common billing advice may be incomplete or misleading and highlights the areas where official guidance matters most.

Article Sections

1. Modifier 59 facts

   Explains the topic of modifier use in relation to same-session services and payer guidance. The section also references Medicare contractor communication and related repeat-procedure modifiers.

2. Combining MSP with consults could lead to issues

   Discusses Medicare secondary payer situations involving consultation claims and general billing considerations for services that may be processed differently by the primary payer and Medicare. The section references CMS guidance and documentation concerns.

3. Use caution when waiving copays

   Covers patient payment waivers, discounts, financial hardship considerations, and compliance risks related to routine forgiveness of copayments and deductibles. The section also touches on documentation and collection efforts.