Wiki Modifier -22 Medicare insurance

[shruthi]

We are experiencing denials on most of the accounts submitted with 22 modifier. Despite of submitting the claims with medical records after denial, we are not getting additional reimbursement of 20%.
Please suggest how to overcome this issue.

Is there anyone facing the similar issue.

Regards,
Shruthi.

 

[cgaston]

Make sure the time is documented and what additional work was required.

The report needs to describe in detail the increased work involved in the case. If the report simply states "this case took longer than usual" it is not enough to warrant additional payment. The more detail the provider provides the more likely the additional services will be approved.

 

[CodingKing]

CMS wont pay of they don't think its significant enough documentation to warrant the 22

 

[sarab86]

Im in Florida so I work with First Coast. On all of my -22 claims, I get a letter from Medicare requesting a concise statement with medical records. Most of the time I have to appeal all the way to the C2C(2nd level) appeal board before the payment is approved. I know going in that with Medicare its going to take a few tries. I don't win them all but most of them get additional payment when they are sent to C2C for appeal. I also make sure to do the math for them on my appeals so they know what Im expecting.

 

[Colliemom]

how about Aetna Medicare, is anyone getting increased reimbursement with use of the -22 modifier? (with proper documentation)

 

[coop22]

I work in cardiac surgery. We have only used the 22 modifier with Medicare. I submit charges. Then two days later we get the ICN number and fax in the operative note. From there they decide if they should pay the additional amount. 9 times out of 10 they pay. (we don't use it often)We always use the 22 modifier on the primary code of the case. I have not tried it on a multiple code. That being said if the primary code description is the procedure that took more work 22 goes on. Secondary or add on procedures I have not applied it.

From my understanding with Aetna a claim is to be submitted (certified) With a Letter attached stating the reason for the increase in payment. With the operative note attached. They have changed their 20% down to 15% being the highest amount paid.

 

[Colliemom]

thank you