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Experts: PT Network Appears to be Inflating Bills Using Coding Modifier

02/19/2015
said some payers have noticed that nearly all of the bills coming through an unnamed physical therapy network since 2009 have included the number 59 a Current Procedural Terminology code modifier attached to a bill to indicate that two services performed in succession should be reimbursed

Category: News

Medical Bill Review: How Much Scrutiny Is Enough?

09/01/2016
abused. Clinical laboratory services physical therapy diagnostic radiology and podiatry are the top areas where modifier 59 abuse is found according to Verscend. In 2015 the company found that about 20 of claim lines eligible for modifier 25 had coding errors or were unsupported; for modifier 59

Category: News

TWCC Advisory Provides Guidance on Fee Schedule

05/14/2004
Specific Services listed in Rule 134.202e. While the Commission modifiers are required for Commission Specific Services these modifiers should not be used when coding other services. As an example the Commission modifier "WP" should not be used when billing for a non-Commission Specific Service such as

Category: News

Workers' Groups Contend Employers Are Ignoring Safety Programs

11/07/2012
on NYCIRB's governing board said Tuesday some employers also are ignoring Code Rule 59. The rule imposes a 5 premium surcharge on all employers with payrolls greater than 800000 a year and an experience modifier of more than 1.2 that don't adopt state-approved workplace safety programs. NYCIRB

Category: News

Diminished Future Earning Capacity Factor Can Be Rebutted

05/31/2012
evaluation of Dahl's whole person impairment and the 2005 Permanent Disability Rating Schedule Workers' Compensation Administrative Law Judge Christopher Miller issued Dahl a 59 permanent disability rating. Miller rejected Dahl's argument that her permanent disability should have been awarded at a

Category: News

Procedures for Establishing the Maximum Amount of Reimbursement Due.

12/17/2020
performed during the same operative session the first or major procedure shall be coded with the appropriate CPT code without a modifier and shall be paid at the lesser of billed charges or the APC base payment rate times 1.3. ii The second procedure shall

Category: Regulations

Procedures for Establishing the Maximum Amount of Reimbursement Due.

12/17/2020
performed during the same operative session the first or major procedure shall be coded with the appropriate CPT code without a modifier and shall be paid at the lesser of billed charges or the APC base payment rate times 1.3. ii The second procedure shall

Category: Regulations

Paduda: Are You Being Gamed?

02/26/2018
state rules — for example a denial of an assistant surgeon’s fee or physical therapy 59 modifier. These savings don’t generate additional fees for the vendor as they arise from mere application of state regs and fees. One would think this is an objective result and therefore

Category: Industry Insights

Insurer Authorization and Medical Bill Review Responsibilities.

12/18/2020
claim administrator or any entity acting on behalf of an insurer shall report to the Division the procedure codes number of line-items billed diagnosis codes modifier codes NDC numbers and amounts charged as billed by the health care provider when reporting these data to the Division

Category: Regulations

1st DCA To Review Whether Voc Expert Testimony Can Rebut DFEC

01/19/2015
medical records technician. Based on agreed medical examiner Mechel Henry's evaluation of Dahl's whole-person impairment and the 2005 Permanent Disability Rating Schedule Workers' Compensation Administrative Law Judge Christopher Miller issued Dahl a 59 permanent disability rating. Miller

Category: News

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