NCCI EDITS AND MODIFIER 59 CHANGES

$99.00$149.00

The Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits every quarter. Effective with dates of service on and after July 1, 2019, CMS is changing how modifier 59 is appended to a CPT code(s) on the claim form. Continue reading for the full webinar description and objectives.  Click below to learn more about the course objectives or to purchase by credit card or check.

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PAYMENT BY CHECK:

To pay by check, please fill out the REGISTRATION FORM BY CHECK and submit with your payment to the address on the form. If you have any questions, please contact Michelle at 661.350.6187. 

COURSE DESCRIPTION:

National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices in outpatient therapy as well as other services. NCCI edits were first implemented in 1996 by the Medicare program and applied only to private practices. In 2000, the Medicare program expanded NCCI edits to hospital outpatient departments and in 2006; NCCI edits were expanded to all other outpatient settings (i.e. skilled nursing facilities, CORF’s rehabilitation agencies, and home health agencies providing Part B services) under the Medicare program.

Modifier 59 is used by outpatient therapy providers to bypass certain NCCI edits and allow the payment of more than 1 CPT code billed on the same day that an insurance carrier may consider should be bundled and separate payment should not be made. Because of this, modifier 59 is not only the most commonly used modifier, it is also the most commonly abused modifier. In addition, the need to use modifier 59 is not only within the same discipline but may also be required when a patient is receiving multiple disciplines from the same provider on the same date of service.

On July 1, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement version 25.2 of the NCCI edits and will change how modifier 59 is appended to the CPT code(s) on the claim form. This 1.5-hour webinar program will explain NCCI edits, the use of modifier 59 and what code(s) to append modifier 59 to on the claim form. In addition, the webinar will provide detailed and realistic examples when providers of outpatient therapy services would utilize modifier 59. Examples will include all 3 disciplines as well as how speech therapy billing impacts the physical and occupational therapy codes billed the same day. Lastly, participants will receive Gawenda Seminars & Consulting NCCI Version 25.2 “cheat sheet” to assist them in knowing when to apply modifier 59 to a CPT code on the claim form.

OBJECTIVES:

At the conclusion of this webinar presentation, participants will:

1. Describe and understand NCCI edits and the use of modifier-59 for outpatient therapy services
2. Describe and understand column 1/column 2 NCCI edits and which CPT code(s) requires modifier 59
3. Be able to use the NCCI edit “cheat sheet” to append modifier-59 to the correct CPT code(s) on the claim form
4. Recite how one discipline’s billing may cause another discipline’s billing to require modifier 59
5. Understand the documentation that must be present in the medical record to support the use of modifier 59

ABOUT THE SPEAKER:

Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. and Director of Finances for Kinetix Advanced Physical Therapy Inc., a private practice located in southern California. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website, www.gawendaseminars.com, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.

Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.

Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.

WHO SHOULD LISTEN:

Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.

INCLUDED IN YOUR MATERIALS PACKET:

In addition to the expertise and advice presented during this webinar conference, you’ll also receive a handout (in PDF format) that will include related reference links as well as Gawenda Seminars & Consulting NCCI Edit Version 25.2 “Cheat Sheet” for use of modifier 59 in outpatient therapy.

CEUs

A certificate of attendance will be available upon purchase of the webinar and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference listened to via a CD of the live presentation that occurred on June 19, 2019.

LENGTH OF TIME FOR PLAYBACK or AUDIO FILES:

Time:  Approximately 1 hour and 39 minutes  (including Q&A time recorded)

REFUND POLICY

There are no refunds once your order has been processed since the handouts/links will be emailed to you immediately after your order has been completed. CD’s will be mailed the following business day by regular US mail.

System Requirements Required To View Webinar Playback Link On Computer:

Venue system requirements:

  • Microsoft Internet Explorer 7+, Mozilla Firefox 2.5+, Safari, or Chrome
  • 1024 x 768 screen resolution
  • Stable Internet connection, DSL or above
  • Wired Internet connection; wireless is not recommended
  • Flash Player 9 or higher
  • Disabled pop-up blockers
  • Computer speakers for participants

Note:  Android Smart Phones (i.e. IPhone) are not compatible.

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DISCLAIMER

*** This WEBINAR PLAYBACK LINK/CD and HANDOUTS  is not to be distributed outside of your organization. If you have a larger organization and have multiple locations, then please contact us at seminars@gawendaseminars.com for pricing.

 CONTACT US

If you have questions about registration or logistics for this webinar conference, please contact the Webinar Conference Manager:

Michelle Gawenda at 661.350.6187 or contact Rick or Michelle via email by filling out our contact form.