June 24, 2022
Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.
Skyline Urology to Pay 1.85M to Settle False Claims Act Allegations of Medicare Overbilling
Also Corporate Integrity Agreement
OIG Audit Modifier 25
https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
NCCI Policy Manual: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare
Chapter 7: GU System
The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
Cigna:
https://www.cmadocs.org/newsroom/news/view/ArticleId/49780/Cigna-to-require-medical-records-for-all-modifier-25-claims
Cigna’s Modifier Policies: https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalModifiersPolicies.html
Cigna’s Modifier 25 Policies:
https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf
Horizon BCBS: Beginning on August 1, 2022
BCBS of Massachusetts: Effective July 18, 2022,