When RAC contractors start complex reviews of Medicare Part B claims, they will likely hit practices in a weak spot, physicians’ use of CPT modifier -25, according to a report by the RAC Monitor.

As the RAC contractors ready themselves in the bullpen for their entry into complex review of Part B claims, it is expected that physicians will receive many “blasts from the pasts” as part of the ...

Modifier 25 is a vital billing tool in orthopedics, used to show when an evaluation and management service is distinct from a procedure performed on the same day. When applied correctly, it ensures ...

Medicare payment rules normally do not permit additional payments to physicians for evaluation and management (E/M) services performed on the same day as a therapeutic procedure. However, if the E/M ...

In general, Medicare considers E/M services provided on the day of a procedure to be part of the work of that procedure. Q: A patient with a history of hypertension and high cholesterol visits a ...

Several commercial payers have adopted stricter reimbursement policies to deny modifier -25 claims upfront, according to Joette Derricks, a healthcare compliance and revenue integrity consultant who ...