Use Modifiers Carefully To Avoid Audits

If you commonly use modifier V57.1 (Other Physical Therapy) in your medical billing claims, be on the alert that the close scrutiny that started in 2006 will continue for your medical billing claims submitted. The reason for the close scrutiny is that some medical billing claims were submitted with medically unnecessary services actually done by the physician. This review started in Iowa and now is taking place in many states and will continue to do so until all states have been audited.

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!

If you don’t already outsource, audits like these may be worth letting a medical billing partner compile your claims as then you can rest assured that your claims will be done correctly and your practice will above scrutiny over modifier audits. Along with that, you’ll also get the bonus of having your medical billing claims turned around faster and the best possible reimbursement on every single claim!

View all Articles by: Kathryn Etienne, CCS-P