athenahealth’s May Rule of the Month
Welcome back to the athenaPulse Rule of the Month. This month we discuss how athenahealth’s Rules Engine alerts clients to both potential and invalid modifiers.
The issue:
Modifiers are a complex and yet very important part of the medical coding language. Modifiers add important details to claims in order to present payers the “full story” behind the procedure. Appropriate modifiers are vital to submitting clean claims ready for quick adjudication, but, modifiers can also be very confusing and easy to forget. Below are just a few examples of athenahealth rules that address modifiers:
- Was the service unilateral, bilateral or global?
- Are you billing for the professional component, the technical component or both?
- Was there something unusual about the procedure? Was it more extensive, discontinued, reduced, or repeated?
- Are you billing for the surgical care only?
- Are you billing for services in a teaching hospital?
- Did physical therapists perform a service?
- Was the equipment new or rental?
- Did you have an ABN signed?
The solution:
athenahealth’s Rules Engine notifies clients when they are billing for a situation which may require a modifier or one which the supplied modifier is actually invalid for the specified charge. The Rules Engine also alerts clients when the particular procedure requires additional modifiers which provide additional and necessary information to the payer such as:
- Assistant surgeons
- Global periods
- Routine foot care
- Multiple births
- Therapy caps
- CLIA
- DME
Our list of rules goes on and on! Yes, modifiers may be pesky two-digit characters but their importance cannot by underestimated as they relay vital information for claim adjudication. athenahealth’s Rules Engine helps your practice get it right the first time around – getting you the money you deserve two digits at a time!