Modifiers and their Role in Billing

Modifiers are used to modify payment of a procedure code, assist in determining appropriate coverage, or otherwise identify the detail on the claim. The use of modifiers ensures the appropriate reimbursement by the insurer. Modifiers are entered in box 24 D on the...

Medical billing information

General Billing Guidelines · All fee schedules need to be reviewed and updated yearly. The Custom Fee Analyzer can be purchased and used as a guide for reviewing the outpatient fee schedule for the facility. The Analyzer begins with a detailed process on how to review...

Consultation cpt codes

• It includes services rendered by a physician whose opinion or advice is requested by another physician or agency in the evaluation or treatment of a patient’s illness. • Consultations may occur in a home, office, hospital, extended care facility and so on. •...

Pre Authorization and referral authorization

Pre-authorization: • A system whereby a provider must receive approval from a staff member of the health plan, such as the health plan Medical Director, before a member can receive certain health care services. • It relates not only whether a service of procedure is...