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Wiki Modifiers and Secondary Payers

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syounger

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We are receiving request from secondary payers to change the modifiers on the claim to be paid? As far as we are aware we can’t bill one insurance one way, and then change the modifiers for the secondary insurance. Any suggestions? Thank you.
 
What modifiers are you being asked to change? Some modifiers are coded based on documentation and to change those would cause your coding to be inaccurate - if this is the case then it would not be appropriate to change them just to get payment. But some payers do have unique and specific guidelines for modifier use, in which case they should be able to direct you to their written, published guidelines for this. If that's the case, then it may be appropriate to change the modifiers in order to comply with their requirements. It really depends on the situation, but I would not change any modifiers or coding unless you have something in writing to back you up.
 
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