tci Part B Insider - 2005 Issue 44

MODIFIERS: Prepare For Audits Of Modifiers 25 And 59

Pitfall:  A quarter of modifier 59 claims didn't have enough documentationThe HHS Office of Inspector General cast a spotlight on your use of the 25 and 59 modifiers, and the results weren't pretty. Bad news: The OIG found a 40-percent error rate for the 59 modifier in its sample of claims, and a 35-percent error rate for the 25 modifier. In both cases, the OIG encouraged the Centers for Medicare & Medicaid Services to sic the Part B carriers and Recovery Audit Contractors on your claims that use these modifiers. You can expect to see a lot more prepayment...

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