Are ASC Modifier 59 Errors Triggering Audit Exposure?

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Yes, ASC Modifier 59 errors can trigger audit exposure when documentation does not clearly justify that procedures were distinct and separately billable. In Ambulatory Surgery Centers (ASCs), incorrect or unsupported use of modifier 59 often raises red flags for payers, increasing the risk of claim denials, payment recoupments, and compliance reviews. Modifier 59 is commonly used to indicate that a procedure or service was distinct from another service performed on the same day. However, when it is used incorrectly, payers may interpret the claim as an attempt to bypass National Correct Coding Initiative (NCCI) edits. This is why ASC Modifier 59 errors are closely monitored by insurers and regulatory agencies. Why Modifier 59 Is Frequently Scrutinized in ASC Billing ASCs handle high volumes of surgical procedures, and accurate coding is essential to ensure compliance and proper reimbursement. Modifier 59 is intended to identify separate procedures because they involve the follow...
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Why does your Staff Fail to Collect Revenue from Patients?

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After 25 years of training medical practice staff how to successfully ask patients to pay at the point of service, there are many common excuses that we hear when staff members fail to collect Revenue from Patients. As per the Consumer Financial Protection Bureau (CFPB) report released in December 2014, 43 million citizens have overdue medical debt and a staggering 52 % of all debt on credit reports is from medical billing. The findings of the study clearly indicate that patient collection is becoming a  serious threat to the profitability of the provider’s office. Factors like ongoing economic instability combined with the implementation of the Affordable Health Care Act and the shift in payment models to be consumer-direct with high deductibles have all consolidated into greater difficulties for the provider’s office at revenue collection from patients.

Reasons Your Staff Fails to Collect Revenue from Patients

To elaborate, here are a few reasons why provider’s offices fail, and steps the office can take to increase collections from patients: 

1. Vague financial policy and procedures

Medical billing and revenue cycle can be complex and confusing concepts. The lack of crystal clear written policies and procedures at the disposal of the provider’s staff only aggravates the problem. Ideally speaking, the policies should clearly outline what the payers consider acceptable and information in terms of patient payment timing and extended payment plans.

The staff should be educated about the difference in payment responsibilities when the patient is not insured, out of network, and alternatively covered by a contracted plan; something the staff of medical revenue billing services is well-versed with.

2. Sharp rise in the volume of patients

Approximately, 40% of adults, who were earlier not covered by payers due to factors like age, gender, health history, etc., will now obtain coverage, thanks to the new Affordable Health Care Act which requires insurance companies to cover such cases regardless of pre-existing conditions. As a result, a substantial rise in health insurance enrollments is impending.

Quantum could become an issue and if that happens, quality would be at an obvious risk. The new rules also provide for increased expenses and thus more confusion. The trend is bound to result in more medical billing errors and the necessity to re-submit claims. Indeed, the provider’s staff is bound to find itself at the end of its wits if not trained to be well-acquainted with new procedures. Read Continue: Why Does Your Staff Fail to Collect Revenue from Patients?

Location: United States

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