The appropriate use of Modifier 25 can be a tricky because the requirements are ultra-specific. Modifiers continue to be problem for most physician practices. Appropriate documentation is important to reduce the number of suspended or rejected claims. On the other hand, Modifier 25 is really convenient because it gives the opportunity to capture additional physician work done when separate E/M services are provided at the time of another E/M visit or procedural service. And, it’s a more efficient use of both the physician and patient’s time by saving additional trips to the doctor’s office.
Many providers are receiving the warning letters by the private payers who bill E/M codes with modifiers significantly more than their peers. Inappropriate use of Modifiers may lead to increasing claims denial, OIG Investigation, wasted follow-up time and loss of revenue.
The expert Elin Baklid-Kunz, MBA, CHC, CPC, CCS, will provide you insight on common Modifier 25 coding mistakes and how to ensure correct coding and payment at the first time.
After attending the session, participants will be able to:
- Understand the compliance risk with inappropriate use of Modifiers
- Learn how to appropriately use the modifiers
- Understand how private payers differs
- Learn best practice to improve compliance
- Review available education resources and links
Areas Covered in the Session:
- Compliance Risk & OIG’s Report
- Compliance Risk
- Recent Fraud Settlements
- OIG’s Work Plan & Report
- E/M Modifiers
- Global Package vs. E/M Modifiers
- CMS Policy
- Appropriate Use & Scenario
- Minor Procedure & E/M Service
- Preventative Services
- Private Payers & Appeal Resources
- Private Payer Warning Letters
- Dispute Resolutions
- Appeal Resources
- Billing Specialist
- Coding Professional
- Practice Manager
- HIM Directors
- Compliance Officers
- Case Managers
About the Presenter:
Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS, is an expert in medical coding compliance who supports clients in matter across the United States with over 20 years of experience in the field. Ms. Kunz is a national speaker and published author. Recent speaking engagements include the 2018 European Symposium on Ethics and Governance in Paris for the Organization of Economic Cooperation and Development; American Bar Association 2018 Physician Legal Issues Conference, 2017 American Health Information Management Association National Conference; 2016-2008 American Academy of Professional Coders Coding & Compliance workshops; 2018-2009 keynote presentations for Eli Research Coding Institute & Audio Educator.
In addition to teaching documentation guidelines and ICD-10 to physicians, Ms. Kunz’ experience includes six years as an adjunct professor and curriculum developer at Seminole State College where she taught courses pertaining to healthcare reimbursement and data analysis and served on the advisory committee for the health information management (HIM) program.
Ms. Kunz earned her master’s degree in business administration from Stetson University where she currently serves as Head Judge for the Southeast Regional Business Ethics Case Competition. She is certified in Healthcare Compliance. She is a Certified Professional Coder; a Certified Professional Medical Auditor; a Certified Coding Specialist and an American Health Information Management Association-Approved ICD-10-CM/PCS Trainer.
Ms. Kunz has enormous practical and personal experience with serious compliance issues. She was the Director of Physician Services for Halifax Health in Daytona Beach, Florida until she discovered Medicare fraud being perpetrated by the Hospital and worked with federal authorities to stop it. In 2014, Halifax settled the matter with the U.S. Department of Justice by repaying to Medicare $86 million. Ms. Kunz’s extraordinary efforts to ensure compliance resulted in her being awarded the 2014 Taxpayers Against Fraud Whistleblower of the Year award.
You will receive an email with login information and handouts (presentation slides) 1 day before the live webcast that you can print and share to all participants at your location.
Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly
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Toll-Free No: 1-302-444-0162
Email: [email protected]
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