For businesses, the cost of health care has skyrocketed in
recent years. Keeping health care costs at a minimum is a constant challenge.
One of the best ways to keep your health care costs in check is to audit the
medical bills your company receives to ensure any incorrect charges are caught
and corrected. Medical billing mistakes happen more often than you probably
think, so thorough auditing really could save your company a significant sum of
money.
The way medical billing works is like this: A patient goes to
the doctor or hospital. All of the services rendered are documented. Each
medical service or procedure has its own billing code as defined by the Current
Procedural Terminology (CPT) code set that is maintained by the American
Medical Association. These CPT codes are used in the billing process to create
claims that are sent to the payer (your company and/or the insurance provider).
In some cases, modifiers (two-digit codes appended to CPT codes) are used to
denote that a service or procedure has been altered by a certain circumstance.
Unfortunately, modifiers are often misunderstood and misused
by health care providers, leading to incorrect charges and excessive fees
charged to companies. That’s why it’s so important that you have someone who
understands proper application of modifiers reviewing your bills.
One commonly misused modifier is Modifier 50. This modifier
is used to identify that a bilateral procedure has been performed in the same
operative session. In other words, when certain surgical procedures are
performed on both sides of the body during the same operative session, Modifier
50 may apply. Reimbursement for such procedures is 150 percent of the allowable
charge (100 percent for the first side, 50 percent of the allowable charge for
the second side).
However, there are some specific rules and exemptions that
more thoroughly define when Modifier 50 should be used.
Modifier 50 should not be used for procedures that are inherently
defined as bilateral. For example, CPT 58671 is a procedure defined as the
occlusion of both oviducts, so it’s already defined as a bilateral procedure
and wouldn’t need the additional Modifier 50 applied to it.
It’s also important to note how Modifier 50 should be billed.
It’s often billed inappropriately, leading to excessive charges. It should be
billed on a single line or on two separate lines in some cases with proper
appending.
Examples of
Billing Modifier 50
Correct:
-64483-50,
payment made at 150 percent of fee schedule
Correct:
-64483-RT, payment made at 75 percent of fee schedule
-64483-LT, payment made at 75 percent of fee schedule
Incorrect:
-64483, payment made at 100 percent of fee schedule
-64483-50, payment made at 150 percent of fee schedule
As you can see, in the final example of incorrect billing,
the payer would end up being billed almost double the amount they should have
been charged!
That’s why it’s so important that businesses have a cost
containment program in place that includes medical bill auditing. Proper bill
auditing is the only way to catch these mistakes and ensure they are corrected
so your company keeps its costs in check.
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