A Common Reason for Rejection

One way that many medical billing claims get rejected for the smallest of errors. In many cases it can be something as simple as an incorrectly used modifier causing your claim to be rejected by the carrier. There are two modifiers that get a lot of people in to trouble in the form of rejected claims as they can be confusing and those are modifier 25 and 57.

Modifier 25 which reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact coding you can assign.

In the previous wording for Modifier 57 it caused some confusion with Modifier 25. If you haven’t updated your CMS coding, be sure you have the latest as 57 now simply reads, ” Decision for Surgery”. If there was no such decision made on your medical billing claim, be sure not to use that particular modifier any longer.

If your busy practice doesn’t have time to keep up with the fast changes in the medical coding industry, you’re costing yourself a lot of revenue in terms of unpaid and rejected medical billing claims that will significantly affect your cash flow.

Consider outsourcing your medical billing claims to the pros who make it their business to stay ahead on the industry changes and get your medical billing claims reimbursed normally within 14 days. Plus your staff won’t have the headache of compiling the coding and having to remember which modifier is used at which time. Look into outsourcing today!

View all Articles by: Kathryn Etienne, CCS-P