tci Part B Insider - 2019 Issue 1

Recovery Audit Contractors: RACs Zero in on Modifier 57 Usage

Study CPT® guidance for a better understanding of this tricky modifier. Not only do modifiers help Part B practices explain services and special circumstances to CMS, but they help providers get the reimbursement they deserve. However, choosing the correct modifier can be a daunting and confusing task, and that may be why modifier 57 (Decision for surgery) was recently added to the Recovery Audit Contractors’ (RACs) junkets. Background: RACs review Medicare claims for errors and collect a contingency fee based on the amount they recover. Much like MACs, there are different RAC contractors for the various regions in the...

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