Medical Billing & Credentialing News

Medicare modifiers are two-character codes that healthcare providers append to  Current Procedural Terminology (CPT)  and Healthcare Common Procedure Coding System (HCPCS) codes when submitting claims to Medicare. These seemingly small additions carry significant weight in the medical billing world, as they provide crucial context about how, when, where, and why a particular service was performed. Think of  modifiers  as the fine print that tells the complete story of a medical procedure. Without them, a claim might look routine on paper, but the reality could be far more complex. A surgical procedure performed on the right hand versus the left hand, an emergency service provided after hours, or a diagnostic test repeated for medical necessity. These distinctions matter enormously for proper reimbursement and compliance. The Foundation of Medicare Modifiers Medicare modifiers  serve multiple essential functions in the healthcare billing ecosystem. They help prev...

  Medicare, Medicaid Fraud Examples and Steps to Ensure You Don’t Commit It A medical doctor invoiced his patient’s Medicare insurance for both the services he actually delivered and for services that were not delivered. He fabricated his patient’s medical records to indicate office visits and treatments that never took place. A gerontologist obtained the outcomes of medical testing executed by a diagnostic firm for her interpretation of the results. She billed the patient’s Medicare insurance as if she performed both the testing and interpretation of the tests. A family physician worked at a medical center where low-income and needy patients were enlisted to submit to needless exams. While he consulted with few patients, medical records were forged by a physician’s assistant to support the billing of Medicaid for medical procedures never performed. Patients with Alzheimer’s disease were sitting unsupervised inside a small room of a medical psychological care facility watching the ...