Importance of Modifiers

Tuesday, March 19, 2013 13:23 Share
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The importance of modifiers in Coding is that they play a vital role in medical claims processing. Therefore, Healthcare Facilities and Providers must show extra care while using modifiers in the medical billing and coding process. If they fail, then there could be serious repercussions concerning reimbursement. In general, what are modifiers and why are they so important in the medical insurance billing and coding process? Let’s get into these details,

Elucidation: In simple terms, modifiers are two digit alpha, numeric or alpha-numeric codes, which shed more light on the Codes for a specific procedure or service performed by a Provider. These modifiers will be of great help to third-party payers, especially when they process medical coding & billing claims of a Provider. They contribute a great deal to the proper reimbursement for a Provider’s services.

Role: Modifiers clarify insurance payers on the following aspects,

  • They explain whether the provider services had technical component or professional component or a combination of both
  • They specify if more than one physician was involved in rendering a particular service or procedure
  • If a service was performed in more than one location, then it is clearly indicated
  • Modifiers also clarify if a service was performed completely or partially
  • If an optional extra service or a bilateral service was performed, then they are coded with their respective modifier codes
  • They clearly indicate if a service was performed more than once
  • If mishaps occurred during the course of service, they are coded in detail

Thus, modifiers have a great responsibility in deciding the accuracy of medical billing and coding.

Impact: If the medical coding/billing staff show negligence while coding modifiers, then the respective Healthcare Facility or Provider will face a huge revenue loss. For instance, if a provider has performed bilateral services, then the billing report must be coded with Modifier 50. On failing to code properly, the provider will be underpaid. Modifiers like 26, 23 and QZ help prevent the denial of claims.

Why Outsource? Coding modifiers requires a lot of knowledge and can be performed only by highly-experienced coders. With increasing pressure on in-house Coders due to Compliance and ICD-10 migration, medical coding outsourcing would be the prudent choice!

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