Tag Archives: Modifier 25

Modifier 25 Madness – Disguises Continue

Posted September 7, 2018 Last October, Anthem announced that evaluation and management (E/M) services, historically eligible for separate reimbursement when reported by the same provider on the same day as a minor surgery, would be reduced by 50%. Anthem believed that physicians were being reimbursed for “duplicative services” relating to fixed/indirect practice expense when an E/M service denoted by use of the modifier 25 and billed on the same day as a minor surgery. Thanks to organized medicine, led by

Summer Brings the Opportunity to Refocus and Recharge

Posted: June 18, 2018 There are few things in life as universally popular as the season of summer. Warm temperatures, longer days, vacations…there’s certainly a lot to like. Aside from mosquitos and sunburns, summer tends to be an enjoyable time for all to relax and recharge before the hustle and bustle of fall. I’m especially enjoying this summer after what turned out to be an unusually cold and wet spring in Kentucky. The first half of 2018 was also difficult

Another Notch in the Win Column for Kentucky Physicians and Patients

Published March 21, 2018 As most of you are probably aware, last month Anthem agreed to fully rescind its Modifier 25 policy that would have reduced payments for E&M services reported with CPT Modifier 25. Had this policy been put into action, it would have severely burdened our patients and undermined our positions as physicians. Anthem’s official statement, released on Feb. 26, credited the American Medical Association, national medical specialty societies, state medical associations and individual providers with taking the

Anthem – Update Modifier 25

Published Jan. 31, 2018 KMA helps reduce initial reimbursement cut from 50 to 25 percent In October, Anthem announced that evaluation and management (E/M) services, historically eligible for separate reimbursement when reported by the same provider on the same day as a minor surgery, would be reduced by 50%. After discussions between Anthem and medical associations at the national, state and local levels, including KMA, Anthem has announced that the reduction will now be 25%, effective with dates of service

Modifier Madness–Focus on Modifier 25

Background – HIPAA and Standard Code Sets The Health Insurance Portability and Accountability Act (HIPAA) includes administrative simplification  requirements which define standards for certain electronic health transactions. These include claims, enrollment, eligibility, payment and coordination of benefits. These requirements apply to covered entities such as health plans, healthcare clearinghouses, physicians and other healthcare providers that conduct certain financial and administrative transactions. These standards also address the security of electronic health information systems. Under HIPAA a “code set” is any set

Modifier Madness – Put the Patient First

Impact of the Modifier 25 Policy Change In October, Anthem announced that evaluation and management (E/M) services, historically eligible for separate reimbursement when reported by the same provider on the same day as a minor surgery, would be reduced by 50%. This will apply to claims denoted by the use of Modifier—25 processed on or after Jan. 1, 2018. For example, when a physician treats a patient for hypertension and osteoarthritis and the patient also complains of a problematic skin