- Industry News
- Access and Reimbursement
- Law & Malpractice
- Coding & Documentation
- Practice Management
- Finance
- Technology
- Patient Engagement & Communications
- Billing & Collections
- Staffing & Salary
Using Modifiers
I've discovered that the majority of our denials come in response to modifier codes — specifically, modifiers -22, -57, and -59 — and are from the private insurers much more than Medicare. Any tips on how to proceed? Do we drop the use of modifiers for private payers due to the amount of time spent appealing?
Question: I've discovered that the majority of our denials come in response to modifier codes - specifically, modifiers -22, -57, and -59 - and are from the private insurers much more than Medicare. Any tips on how to proceed? Do we drop the use of modifiers for private payers due to the amount of time spent appealing?
Answer: It is very common to receive denials for these modifiers. Sadly, many carriers do not recognize them, unless the practice appeals them.
I would analyze resources by modifier. You'll need to do this analysis based on how much money is at stake and how many resources are expended to get that money. If you can send out a generic appeal letter to get the -22s paid, for example, it's worth your time. That said, be sure to establish boundaries for your staff. For example:
- Appeal once over the phone for all denials.
- Send a written appeal for denials over $25.
- Send two written appeals for denials over $100.
- Solicit physician involvement for claims over $500.
Figure out your own guidelines based on your experience and practice needs.
Asset Protection and Financial Planning
December 6th 2021Asset protection attorney and regular Physicians Practice contributor Ike Devji and Anthony Williams, an investment advisor representative and the founder and president of Mosaic Financial Associates, discuss the impact of COVID-19 on high-earner assets and financial planning, impending tax changes, common asset protection and wealth preservation mistakes high earners make, and more.
Reducing burnout with medical scribes
November 29th 2021Physicians Practice® spoke with Fernando Mendoza, MD, FAAP, FACEP, the founder and CEO of Scrivas, LLC, about the rising rates of reported burnout among physicians and how medical scribes might be able to alleviate some pressures from physicians.
