Fraud, waste, and abuse Insights: Flagging for excessive modifiers скачать в хорошем качестве

Fraud, waste, and abuse Insights: Flagging for excessive modifiers

Read the blog here: https://hubs.ly/Q01K0-Ky0 For circumstances that require services in addition to specific CPT codes, modifiers help providers to properly classify the care or services given. But using excessive code modifiers can be a red flag for fraud, waste, and abuse (FWA) from bad actors. Some modifiers that are broader to allow for extenuating circumstances can be taken advantage of by those seeking undue reimbursement. Misuse of CPT codes, like modifier 59, can result in CMS imposing a penalty of up to $10,000 per claim. In this installment of our Cotiviti FWA Insights series, we will explore a specific case of modifier 59 within pain management—and how Cotiviti’s special investigations unit (SIU) helped identify an overpayment exceeding $1.2 million.