Ok, so hopefully everyone had a safe and happy 4th of July holiday! Today’s morning coffee topic is MODIFIERS.

Do you ever wonder if your staff is using the right modifier at the right time? Do you know what the most commonly misused modifier is?

Ever wonder what can happen when modifiers are inappropriately used?   Hopefully, your staff isn’t applying modifiers when they shouldn’t, and applying modifiers when they should.  But if there’s confusion, what is your liability? Overpayments, claim denials, fines and penalties, loss of revenue and of course the dreaded audit investigations from OIG.

Some modifiers to consider: The “G” modifiers. GA, GZ, GX and GY.  In 2011, Medicare paid nearly $744 MILLION for Part B claims with G modifiers that providers expected to be denied as not reasonable and necessary or as not being covered by Medicare.  However, according to the Office of Inspector General (OIG), they discovered vulnerabilities in how Medicare pays for the claims.  When processing the claims, contractors often do not consider the modifiers that providers use to indicate they expect the services or items to be denied as not reasonable and necessary. This could account for the $4.1 million for claims that included inappropriate combinations of G modifiers.  As a provider, are YOU confident you were paid when you should have been paid?  Are YOU confident G modifiers added to your claims were appropriate? If you’re a client of MBO, not only can we assure you of accuracy, we can prove it!

By now, every provider and their subsequent billing department should be fluent with all G modifiers.  So, let’s talk about newer modifiers.  Effective January 1, 2015, Medicare established 4 new “sub set” modifiers known as the XE, XP, XS & XU. These modifiers were created because of the highly used and highly abused modifier 59. The newly formed XE XP XS & XU modifiers just cleans it up a bit and prevents unintentional abuse of modifier 59 by clarifying why modifier 59 would be appropriate. Moving on, JW is a 2017 modifier to be aware of. If you bill for drugs or biologicals from single use vials or single use packages in which not all was used, you should be billing 2 line items.  1 line item indicating the dosage used, and the 2nd line item for the discarded units, with modifier JW.  Both line items are reimbursable.  CAUTION: Billing for wastage and/or using the JW modifier for drugs supplied in a multi-dose vial is not compliant and should not be done.

Modifiers can be a maze if you’re not completely educated on proper use. The problem with the maze is it can cost the provider lost, or delayed, revenue and more (think audit).

As your MEDICAL BILLING SERVICE providing end-to-end Revenue Cycle Management services, MBO will take the fear and the burden off you.  Allow us to use our expertise and apply the appropriate modifier at the right time, resulting in clean claims, compliance and proper reimbursement!

Medical Business Office, Inc. would love the opportunity to show you how we can enhance your medical practice and ensure reimbursement for everything to which you are entitled while keeping you compliant.  Call us today: 573.634.7155.