Modifiers & Reimbursement – Get Paid More and Faster in 2024

Course Description:

Are you struggling to get your healthcare claims reimbursed? Join this webinar to learn the essential skills of using modifiers correctly. Our expert speaker Edna Maldonado, CPC, ACS-UR, will guide you through coding examples and clarify the hierarchy of modifiers when multiple modifiers are needed for the same encounter. Learn when to append modifiers, the difference between payment and informational modifiers, which ones to use, and the order to use them in. Don’t miss out on this opportunity to ensure appropriate payment for the health care services you provide. This webinar will provide a well round explanation on the proper use of modifiers, explain the difference between informational and payment modifiers and what modifier to use to get reimbursement faster.     

Learning Objectives:

• Understand Proper use of modifier to communicate with carriers
• Describe coding information to use in everyday practice
• Apply proper coding for faster reimbursement
• Identify CAT I and HCPCS modifiers
• Know the reimbursement differences when modifiers are used
• Review current documentation to determine changes that need to be made
• Learn the NCCI guidelines on the appropriate use of modifiers
• Be able to apply the correct modifier(s) based on the specific circumstances
• Learn how to properly resolve NCCI edits including a breakdown of -59 and associated -X modifiers
• Proper use of modifier 25, especially in the office or outpatient setting
• Understanding the Modifier 57/54 combination 

Areas Covered in the Session:

• Modifier’s Overview and Uses
• Which Modifiers is Appropriate?
• How to Submit Clean Clams?
• What Modifier do I use first?
• Types of Modifiers
  • HCPCS Level 1 – Developed by the AMA
  • HCPCS Level 2 – Developed by the CMS
• Why use a modifier?
• Modifiers
  • Evaluation and Management Services
  • Surgery/Procedures
• Modifiers For E/M Services
• Modifier 24
• Modifier 25
• Medical Necessity?
• Determining Correct Use
• Modifier 57
• Modifier Guidelines/Usage
• Payment Modifiers
  • Modifier 22 – Increased Procedural Service
  • Modifier 50 – Bilateral procedure
  • Modifier 51 – Multiple procedures
  • Modifier 52 – Reduced services
  • Modifier 53 – Discontinued Procedure
  • Modifier 62 – Co-surgeons
  • Modifier 78 – Unplanned return to the operating/procedure Room by the same physician or other qualified health care Professional following initial procedure for a related Procedure during the postoperative period
  • Modifier 80 – Assistant Surgeon
  • Modifier 81 – Minimum Assistant Surgeon
  • Modifier 82 – Assistant Surgeon when qualified
• Assistant Surgeon
• Informational Modifiers
  • Modifier 58 – Staged or Related procedure or service by the same physician other qualified health care professional during the postoperative period
  • Modifier 76 – Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
  • Modifier 77 – Repeat Procedure by Another Physician or Other Qualified Health Care Professional
  • Modifier 79 – Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period
• Bundling of Modifiers
• Bundling Modifier 59
  • Modifier 59 – Distinct procedural service
• Modifier 59
• Subset Modifiers to Modifier 59
  • XE: Separate Encounter, a service that is distinct because it occurred during a separate encounter
  • XS: Separate Structure, a service that is distinct because it was performed on a separate organ/structure
  • XP: Separate Practitioner, a service that is distinct because it was performed by a different practitioner
  • XU: Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service
  • Example of Proper use 59/XS
• HCPCS Modifiers – AS, JW, JZ

Suggested Attendees:

• Healthcare Administrators
• Healthcare providers
• Physicians
• Coders
• Billers
• Managers
• Residents
• Claims adjusters
• Nurses
• APPs
• Residents
• Reimbursement Staff
• Medical Officers
• Clinic Managers
• Insurance Company Claims Reviewers
• Insurance Payers
• Payment Policymakers
• Other Healthcare Providers

About the Presenter:

Ms. Edna R. Maldonado is a Certified Professional Coder (CPC), Board of Medical Specialty Coding & Compliance (ACS-Urology) and AHIMA ICD-10-CM Trainer. Edna R. Maldonado, CPC, is a bilingual health care management professional that has specialized in urology coding, billing, and training for over 30 years. Her training skills are unmatched, and she has used them to train several coders new to urology to staff AUA’s Coding Hotline. She has also trained and prepared coders for the CPC coding examination. Her leadership extends beyond training, she has also assisted new coders with goal setting, and she has mentored several coders who have moved on to higher positions in urology coding.

Ms. Maldonado’s ambition and drive has elevated her to an expert level in the field of urology coding. She holds herself to the highest standards of professionalism and confidence. She is dedicated to representing her organization and herself in a stellar light by always providing superior results. She is currently the Chair for the Practice Administration Work Group (PAWG) for the AUA, serving as Co-Course Director for the two-day annual Coding Seminar held by the AUA. Ms. Maldonado is an AAPC Officer for her Local Chapter, Frederick, MD.

Ms. Maldonado’s career in urology began in 1990 at Florida Urology Partners (formerly known as Town & Country Urology) where she was hired to manage a busy urology practice by the original owner, Servando Sanchez, M.D. During her time there, Ms. Maldonado was an effective leader with creative skills in interpersonal communications, organizational techniques and problem solving that she used to motivate and to cultivate a diverse staff of eleven. Her time there prepared her for a great opportunity to relocate and join a premier urologic association, providing invaluable support to the urologic community-the American Urological Association (AUA).

Since joining the AUA in 2010, Ms. Maldonado has become a respected and renowned expert in the field of urology coding. She has developed a multitude of urology coding training materials and training techniques for teaching urology coding. As a urology coding trainer, Ms. Maldonado has developed, designed, and recorded content for urology coding CDs, webinars, and virtual training. As an instructor, Ms. Maldonado has been a lead faculty member for urology coding courses including 30 two-day coding seminars, 27 customized coding seminars and over6 conference coding courses.

Additional Information:

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly
• For more information, you can reach out to the below contact:
  Toll-Free No: 1-302-444-0162
  Email: care@skillacquire.com

Snippet From Our Previous Session:

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Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN" 

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer