Modifier 25 Made Simple: Avoid Denials and Get Paid Faster

Course Description

The Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) have identified the misuse of Modifier 25 as a significant compliance concern. Improper application of this modifier can lead to upcoding, resulting in substantial penalties. Commercial payers also scrutinize claims involving Modifier 25, as incorrect usage may indicate billing for services that are not significant or separately identifiable. Therefore, accurate application of Modifier 25 is crucial to avoid audits and ensure compliance with federal and payer-specific billing regulations. This webinar is designed to provide healthcare professionals with a comprehensive understanding of Evaluation and Management (E/M) services and the correct application of Modifier 25. This session will delve into the complexities of Modifier 25, clarifying common misconceptions and offering practical guidance to ensure accurate coding and billing practices.

Learning Objectives

• Understand the criteria that constitute a “significant, separately identifiable” E/M service when performed on the same day as another procedure
• Identify documentation requirements to substantiate Modifier -25
• Learn the appropriate scenarios for appending Modifier 25 to E/M codes
• Gain insights into the necessary documentation to substantiate the use of Modifier 25
• Ensure adherence to payer policies and reducing the risk of audits
• Identify frequent errors and challenges associated with Modifier 25 usage
• Discover strategies to overcome documentation and coding errors

Areas Covered in the Session

• Importance of E/M and Modifier 25 compliance
• Understanding Modifier 25: Definition and Purpose
• Evaluation and Management (E/M) Services
• Defining “Significant and Separately Identifiable”
• Differentiating between routine and additional services
• Global Periods and Minor Procedures
• Essential Documentation Practices
• Avoiding common documentation pitfalls
• Overview of payer-specific requirements
• Frequent Errors in Modifier 25 Application
• Strategies for Accurate Coding
• Detailed case studies illustrating correct and incorrect Modifier 25 usage
• Live Q&A Session

Suggested Attendees

• Physicians
• Physician Assistants
• Nurse Practitioners
• Certified Nurse Midwives
• Medical Coders
• Medical Billers
• Compliance Officers
• Hospital Administrators
• Practice Managers
• Revenue Cycle Staff

About the Presenter

Pam D’Apuzzo, CPC, ACS‑EM, ACS‑MS, CPMA, is a Managing Director at VMG Health leading the Coding, Compliance, and Operational Excellence Management service line. She is a recognized leader and industry expert in coding and compliance. Pam’s 30-plus years of healthcare consulting experience spans academic medical centers, community hospitals, faculty practice plans, and large private practices.

A trusted adviser to New York’s leading healthcare institutions, she conducts educational and training seminars and provides comprehensive compliance programs. Pam also has a successful record of practice management services including operational and billing review, practice assessment, practice start-up assistance, and EMR implementation.

Pam is a frequent speaker at conferences sponsored by the American Academy of Professional Coders (AAPC), Health Financial Management Association (HFMA), New England Healthcare Internal Auditors (NEHIA), California Health Information Society (CHIA), New York State Society of Physician Assistants (NYSSPA), Suffolk County Medical Society (SCMS), and American Association of Gynecologic Laparoscopists (AAGL).

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com

Address:- 651 N. Broad Street, Suite 206, Middletown, DE 19709

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

All tickets include recording of the event.