Medicare Compliance & Reimbursement

Modifier 59 misuse led to millions in overpayments. When the OIG talks, not everyone listens, a new report indicates. The OIG makes hundreds of recommendations each year, advising practices and carriers to tighten up documentation, correct their modifier use, or implement additional programs. On March 11, the OIG released its 202-page "Compendium of Unimplemented OIG Recommendations," which revealed that many OIG suggestions have been ignored. Case in point: In 2003, the OIG found a 40 percent error rate on claims that contained modifier 59 when used to separate Correct Coding Initiative (CCI) edits, resulting in Medicare paying $59 million in improper payments. The OIG encouraged carriers to institute prepayment and post-payment reviews of the use of modifier 59, and suggested that CMS should update carriers' claims processing systems so they pay claims with modifier 59 "only when the modifier is billed with the correct code," the OIG report indicates. The [...]