Medicare Audit Defense - Medicare Appeals - Use of Modifier 25
Jackson Davis HealthCare (JDH) professionals lead the way in assisting both hospitals and physicians in appealing Medicare audits, understanding Medicare coverage criteria and CMS payment criteria for the use of modifier 25.
The implications & challenges of billing with modifier 25 cannot be overstated. Hospitals have been using modifier 25 since the introduction of the Outpatient Prospective Payment System (OPPS) in FY 2000 for ER services, wound care and outpatient clinic visits. Physicians have been using modifier 25 for over 20 years in connection with minor procedures, E&M office coding and ER visits.
Medicare audits for the proper use of modifier 25 are increasing at an alarming rate. As recently as August 2011, Geisinger Medical Center in Philadelphia settled a $1.3 million case with the U.S. Attorney's Office for use of modifier 25. Are you a hospital or physician facing a RAC audit, OIG audit, DOJ audit, ZPIC audit or other CMS contractor audit for the use of modifier 25? AdvanceMed, Health Integrity, SafeGuard Services, Trust Solutions and a wide range of other CMS contractors are actively auditing both hospitals and physicians for the "inappropriate" use and billing of modifier 25.
Please contact us directly at (303) 586-5003 and we would be glad to respond to any questions you may have regarding the use of modifier 25 for outpatient Medicare services. Medicare Program Integrity Audits (PI Audits) - Jackson Davis HealthCare works closely with providers to complete proactive, detailed & comprehensive Medicare Program Integrity audits (or "PI Audits"). Each Medicare PI audit is centered on documented, codified CMS payment criteria and Medicare coverage criteria for selected focus areas and traditionally includes a pre-determined sampling of 10 - 500 patient encounters. Each encounter is pre-screened and carefully selected based upon Medicare current or anticipated audit focus areas. Let JDH physicians, nurses and Medicare compliance professionals go to work for you!
Physician E&Ms / Wound Care Clinics / Emergency Room Visits - Use of Modifier 25
This presentation will address a key focus area that is rolling out nationwide on the permanent Medicare audit program - Physician Evaluation & Management services / Wound Care Clinic services / Emergency Room Visits - Use of Modifier 25. Several previous Medicare audits, error evaluations, probes and directives have highlighted a wide range of challenges regarding the accuracy of ER visit definitions. This discussion will provide an in-depth look at physician evaluation & management coding, wound care clinic visits, ER visit definition, billing, claim submission requirements and the most recent CMS directives regarding modifier 25.
Please send your registration request and contact information to us via e-mail at support@modifier25.com. Registrations must be received no later than September 19. You will receive an e-mail confirmation with sign-on information and password prior to September 20. The cost is $159 per healthcare provider.
For questions regarding CMS efforts to stop Medicare fraud & abuse, Medicare audits, Medicare appeals, RAC audits, ZPIC audits or other Medicare legal support services, please contact us directly at (303) 586-5003.
How Can Jackson Davis Help?
As your unwavering advocate, Jackson Davis HealthCare (JDH) leads the nation in completing proactice Medicare program integrity audits and developing winning Medicare appeals. For over 25 years, Jackson Davis HealthCare professionals have dedicated everyday to understanding, documenting, synthesizing and applying Medicare Coverage Criteria for cases being considered for Medicare audits and Medicare appeals - RAC appeals, ZPIC appeals, DOJ appeals, MAC appeals, MIC appeals or individual Medicare beneficiary appeals.
Medicare Appeals - Over the past 25 years, Jackson Davis professionals have worked with providers and attorneys nationwide to appeal 1,000s of Medicare overpayment issues. JDH partners with leading national and international law firms to maintain attorney-client privilege, establish codified work-product relationships and develop winning Medicare appeals. We have established working relationships with the nation's best attorneys and they work hand-in-hand with JDH staff to bring you the best, most experienced and most cost-effective solution for your Medicare appeal needs.
CMS Compliance Advisory Services - Providers nationwide retain JDH for retained monthly counsel or on a project-by-project basis. Our staff is highly experienced and our knowledge and application of Medicare rules and regulations is unmatched in the industry. We are Medicare geeks. From our physicians to our nurses to our compliance reseach team, we are in your corner and available 24/7 for your CMS compliance needs.