Online Training Course

Prod ID: 105
Using Modifiers to Improve Claim Accuracy

Don't lose revenue because of modifier misuse, non-use or to bypass CCI edits! This course will explain modifiers and when it is appropriate to use a modifier to obtain proper payment.

 

 Hear a sample of our course.

CEUs

3

Length

180 min

Price

$239.00

This product is not for purchase at this time.


Modifier usage is an effective way to document the complete patient story and increase communication between providers and payers to report special circumstances with patients. The instructor will share tools and tips to improve the application of modifiers to decrease denials/rejections. Self-supplied CPT® and HCPCS manuals are required to complete practice exercises.

Jan Hailey

MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M

Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program. 

Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.

Federal, state and private payers report that incorrect use of modifiers is among the top reasons for billing errors. Learn correct use and ranking rules when multiple modifer categories are used. Gain examples that explain special modifer usage.  

At least one year of coding/billing experience for outpatient services is recommended.

Highlights:

  • Tips for correct use of -X(EPSU) modifiers
  • List and explanation of Levels I and II modifiers
  • E&M modifiers
  • HCPCS modifiers
  • Surgical Modifiers
  • Guidelines and usage tips
  • Negative impacts of modifiers
  • Sharpen knowledge of CPT® guidelines related to modifier usage
  • Why pricing modifiers are considered part of the seven-digit procedure code by CMS
  • Use of modifiers when services are in the global period
  • The difference between modifiers 25 & 59 and modifiers 52 & 53
  • Inclusion of medical necessity in documentation to support the use of modifiers
  • Audit risks and identification of abuse of modifiers as reported by CMS

On Demand course includes three hours of recorded instruction plus downloadable course materials.

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