This program will improve your knowledge of the role of modifiers in communicating about difficult, increased, separate, reduced, multiple and repeat services and deepen your understanding of CPT guidelines related to modifier usage. The instructor will share tips to improve the application of modifiers and help you decrease denials and rejections. Understand the impact of specific modifiers on payment for the service provided. Review examples that provide clarity on exactly when it is, and when it is not, appropriate to use a modifier. Learn when a special report is necessary and how to properly sequence modifiers when multiple modifiers are needed to delineate a service.
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. Gain confidence that you are properly assigning modifiers and avoid fraud and abuse allegations.
Highlights:
- List and explanation of Levels I and II modifiers
- E/M modifiers
- Surgical modifiers
- Telehealth services modifiers
- Therapy modifiers
- HCPCS modifiers
- Anatomical modifiers
- X(EPSU) modifiers
- Anesthesia physical status modifiers
- 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
- Sequencing of modifiers
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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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.
Participants will learn the guidelines related to modifier usage and gain tips for properly appending modifiers to improve claim accuracy.
No prerequisites required. Self-supplied CPT® and HCPCS code set manuals are required to complete practice exercises.
Self-paced online program includes unlimited review of previously recorded instruction and access to downloadable course materials for 6 months.
Comments from past participants:
"Excellent presentation with helpful scenario examples."
"Very informative and easy to follow."
"Excellent content and instructor."
"I appreciate the reminder of all the modifiers and the examples provided were a great help."
Prod ID: 514
