Medicare Compliance & Reimbursement - 2019 Issue 1
Recovery Audit Contractors: RACs Zero in on Modifier 57 Usage
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Article Overview
This article covers Medicare Recovery Audit Contractor attention to CPT modifier 57 and the broader documentation and claim-review context around E/M services associated with surgery. It is intended for coders, billing staff, compliance teams, and clinicians who want to understand why this modifier is being audited and how the issue fits into Medicare claim review activity. The discussion stays at a high level, emphasizing the topic, audit backdrop, and general categories of guidance without reproducing the premium article’s detailed coding advice.
Why This Topic Matters
Modifier-related claim audits can affect reimbursement, compliance exposure, and how practices document evaluation and management services around surgical care. Understanding the audit focus helps readers determine whether their billing workflows, documentation review, or compliance monitoring may need attention.
Article Sections
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Background on RAC activity
Introduces Recovery Audit Contractors and the Medicare claim review environment that frames the issue discussed in the article. It also notes the broader audit context and why the topic has drawn attention.
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Understand the issue with 57
Summarizes the article’s discussion of modifier 57 and the claim situations being reviewed. This section focuses on the general coding context and surrounding considerations without reproducing detailed instructions.
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Follow this expert advice to avoid RAC interest
Covers broad expert commentary on documentation awareness, audit response, and the importance of reviewing payer correspondence. It addresses compliance-oriented considerations tied to the audit topic.
What You Will Learn
- How Recovery Audit Contractors fit into Medicare claims review
- Why modifier 57 is receiving audit attention
- The general relationship between evaluation and management services and surgical decision-making
- What kinds of documentation and audit-response issues practices should be mindful of
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance professionals
- Physician practices
- Hospital revenue cycle teams
- Clinicians involved in documentation
Modifiers Discussed
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