$1.85 Million Paid to Settle Urology Modifier 25 Whistleblower Case

Separately asking routine evaluation and management (E/M) services provided on a similar day as another procedure is usually denied by Medicare. Care providers might typically individually bill E/M services if they meet certain criteria and append modifier 25 vital, on an individual basis specifiable analysis and management service by a similar MD or different qualified health care skilled on a similar day of the procedure or different service to the claim. Modifier twenty five shows payers, like Medicare, that a care supplier went higher than and on the far side the standard E/M of pre-operative and post-operative care related to the medical procedure; which it had been vital, on an individual basis specifiable service. If this modifier gets used, a supplier unbundles a service and receives further compensation ― overpayments of Medicare bucks. Per a whistleblower, this is what Skyline urology allegedly did between January. 1, 2013 and Dec. 31, 2016.

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