tci Medicare Compliance & Reimbursement - 2017 Issue 15

Reimbursement: Expect Reduced Pay For Modifier 25 Claims, Insurer Says

One payer plans to cut modifier 25 claims in half, and others may follow. You probably use modifier 25 on many of your claims, but the odds of collecting full payment for this ubiquitous modifier are suddenly sinking. That’s the word from Pennsylvania’s Independence Blue Cross Blue Shield, which is making drastic reimbursement changes to the modifier. Inside story: Effective Aug. 1, Independence will reimburse claims appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) &ldquo...

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