A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the random sample underlying the ...

Several commercial payers have adopted stricter reimbursement policies to deny modifier -25 claims upfront, according to Joette Derricks, a healthcare compliance and revenue integrity consultant who ...

Medicare payment rules normally do not permit additional payments to physicians for evaluation and management (E/M) services performed on the same day as a therapeutic procedure. However, if the E/M ...