Modifier v57.1 to Get Close Examination

If you use V57.1 (Other Physical Therapy) in your medical billing claims, be prepared for some close scrutiny of all your submitted medical billing claims.

These claims in particular will be closely monitored to ensure that they were medically necessary services actually done by the physician. This review will be taking place in Iowa and other states are slated to follow suit in the coming months.

Currently, the review will affect Part B Medicare patients only who are part of the outpatient home healthcare program. The reviewers will select home health outpatient claims with type of bill 34X, revenue code 042X and V57.1 as primary.

With the close examinations of medical billing claims and more and more documentation needed to get them even partially reimbursed, it is a good time to consider outsourcing your medical billing claims to a third party partner with the time and expertise to make sure that not only your claims get filed in a timely manner, they get filed right!

When you let an outside partner handle your medical billing claims, you are also taking the microscope of scrutiny off your practice. As long as humans are compiling medical billing claims, mistakes and errors will happen that can result in an audit. By outsourcing your medical billing, your error rate in your submitted claims will commonly fall to just around 1%. This is due to the checks and balances that your medical billing partner has in place to quality control all claims before they are submitted to make certain that all claims have medical necessity, coding is absolutely accurate and the billing is submitted in the format to give your practice the highest reimbursements possible.

View all Articles by: Melissa Clark, CCS-P