Does the documentation justify the CPT and ICD10 billed? – Double check notes on visit to make sure there was enough documentation provided to use the provided CPT and diagnosis codes.   Were the modifiers appropriate or missing- denials can be an easy fix if an incorrect modifier was used or was missing.  Make sure correct…

1. Insurance verification- Most PM Software can double check insurance information right from the patient demographic page, or you can look it up either online or by calling.    2. Referrals and pre-authorization- It is critical to know what insurance plans and what tests/procedures require pre-authorizations and referrals.  Most Tricare, Medicaid plans, and even some…

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How to protect your claims from pesky timely filing denials Timely filing is when you file your claim initially to your primary, secondary or tertiary payer for the first time. The tricky part is all that goes into this process. While you and the staff are treating patients, closing notes, handling scheduling and referrals, pre-authorizations,…

What is modifier 25? Modifier 25 Description  Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service This is among the most common coding mistakes, costing medical practices millions each year in missed reimbursement opportunities and costing insurers millions each year in improper payments. This…