Common Myths About Modifier 59

Common Myths About Modifier 59

Modifier 59 is the outcome of the correct coding initiative (CCI) by Medicare. The use of modifier 59 can be confusing to clinicians and billers of all experience levels.

medical billing and codingThere are a lot of myths surrounding the use of modifier 59, but it will generally be used to designate CPT codes that are separate but can be combined.

The Right Time For Modifier 59

The important thing to remember is that if two codes are related and should be billed together, then append modifier 59.

When the modifier is used, it tells Medicare that the two CPT codes should be billed together, that there’s a valid reason to do so, and that the documentation is available to support that decision.

If two CPT codes are mutually exclusive, then there’s no reason to use modifier 59.

CCI Edits Available At Medicare

CCI edits applicable for any profession are all available on the Medicare website. The initiative was designed to avoid payment for procedures that typically wouldn’t be billed together.

The modifier 59 edit allows clinicians to bill two procedures when they’re related and is used to indicate a distinct procedural service (DPS).

Modifier 59 allows clinicians to differentiate to payers that a specific procedure or service was independent of any other that was billed on the same day for the same patient.

The modifier can be used to indicate a different part of the body, organ or injury. The edits are listed by specific CPT sections and is a free download on the Medicare website.

Alleviating Modifier 59 Problems

The answer to modifier 59 difficulties is the In Touch EMR™ software.

The EMR automatically checks claims, tells clinicians if the modifier is applicable, and which CPT codes need to be appended with the modifier.

Clinicians and billers no longer have to guess about the proper use of modifier 59 and hope that a claim isn’t denied or flagged for further investigation.

medical billing and coding

In Touch EMR™ represents the first generation of EMR technology that can tell the user if a potential problem exists that could result in a denial.

The software system helps billers and clinicians ensure that practitioners are paid, as long as medical necessity has been established.

Health and Human Services continues to update, modify and change its requirements, and reduce Medicare payments to practitioners.

Combined with the new rules and regulations associated with Obamacare, it can be exceedingly difficult to distinguish when to use specific edits and modifiers.

In Touch EMR™ takes the guesswork out of billing for far fewer rejections and denials, while increasing reimbursements.

Common Myths About the Medicare 8 Minute Rule

Common Myths About the Medicare 8 Minute Rule

There’s a lot of confusion about the Medicare 8 Minute Rule and how many units to bill. Calculating the correct number of units can be confusing without the proper training and understanding.

medical billingMany clinicians are unknowingly under billing and cheating their practice out of legitimate reimbursements.

The 8 Minute Rule is being used by Medicare and an increasing number of insurance companies.

Those that don’t follow the Medicare guideline typically bill in 15 minute increments.

For insurance companies that do follow the Medicare rule, each billable unit must be between eight and 22 minutes in duration, but it only applies to timed CPT codes.

The Total Is What Counts

Problems arise when an uneven number of minutes are dedicated to different tasks.

To bill accurately and ensure that they’re adequately reimbursed, clinicians must total all the minutes in the session for the maximum number of billable units.

To be included, only face-to-face time spent with the patient counts toward billable units.

The 8 Minute Rule applies as follows:

  • 1 unit is 6-22 minutes
  • 2 units is 23 to 37 minutes
  • 3 units is 38 to 52 minutes
  • 4 units is 53 to 67 minutes
  • 5 units is 68 to 82 minutes
  • 6 units is 83 to 98 minutes


Understanding Is Essential

Billing becomes more difficult when multiple procedures or services are provided.

When an uneven number of minutes occur, therapists should choose the code that best represents the majority of the treatment time.

To understand the 8 Minute Rule, therapists should talk with a professional biller. Without a full understanding of how the rule works, therapists will encounter errors and reimbursement denials.

Automatic Calculationsmedical billing

The In Touch EMR® automatically calculates the time for each CPT code.

The system knows if it’s a timed or untimed procedure and assigns the appropriate number of units.

Clinicians have full control and can change the claim before it’s sent.

Demonstrations can be scheduled to learn how the software works. It takes the guesswork out of calculations, increases efficiency, and ensures therapists are getting paid the full amount to which they’re entitled.

In Touch EMR Eliminates Scanning and Uploading of Patient Documents

In Touch EMR Eliminates Scanning and Uploading of Patient Documents

With the technology of an iPad and the In Touch EMR, there’s no reason to scan and upload documents to a patient’s record ever again. At this time, the In Touch EMR has the only dedicated iPad app for physical therapy.

In Touch EMRIn Touch EMR stores information securely in the cloud and can be retrieved at any time.

Implemented on the iPad, the EMR offers a fast, easy and simple system with almost unlimited uses.

Say Cheese!

With the iPad’s built-in camera, patients can take a photo of themselves for identification purposes, right in the office.

The photo automatically goes where it needs to be with the integrated In Touch EMR and it’s permanently stored in the cloud.

Patients can also complete forms and photograph them for inclusion in their records.

It’s essential to verify each patient’s identity for reimbursements, prevent fraud and avoid identify theft.

A photo of the patient’s insurance card can be taken and added to their file for quick verification of coverage and services, thereby increasing front desk efficiency.

Photographic Documentation

In In Touch EMR, clinicians can take photos of individuals during the patient encounter to document their posture, injuries and other visible data. The photos are instantly attached to the patient’s record to create a visual profile and establish medical necessity.

Clinicians can snap a quick photo of referrals, documents and records from other providers, all of which becomes part of the patient’s record almost instantly.


Clinicians need to understand the various elements of Obamacare so they can provide explanations to patients.

The In Touch EMR is an important tool for patient education.

Clinicians can use the EMR and iPad as a visual aid to help clients understand what they’re being told verbally. Instructions, examples and pertinent information can be called up, printed and given to patients to peruse at home.

Automating the Workflow

In Touch EMR and the iPad automates the before, during and after patient experience. Staff members spend less effort on time-consuming tasks and patients receive more quality time with their clinician.

In Touch EMR

Billing can be completed and submitted, even before patients leave the office.

The combination of the In Touch EMR and an iPad eliminates the need for scanning, photocopying and uploading information to patient files.

The EMR stores data quickly, safely and securely in the cloud where it can be retrieved any time it’s needed.

Office processes are greatly improved for better efficiency, and clinicians have the ability to create a photographic profile of their patients using In Touch EMR, allowing them to bill quickly and reduce turnaround times on reimbursements.


In Touch EMR and Its Voice Recognition Feature

In Touch EMR and Its Voice Recognition Feature

There are many myths about the use of voice recognition. In the mid-1990s clinicians began using voice recognition with their EMR systems, but they weren’t very accurate for medical records.

In Touch EMRSystems weren’t always able to distinguish from background noise and had difficulty with accents.

Voice recognition systems have come a long way since then and will save clinicians considerable time.

Built In Voice Recognition

The newest computers, devices and operating systems have voice recognition capabilities built in, and most people don’t even know it.

If the computer was built after 2011, voice recognition is built in whether it’s a PC or a Mac, and can be integrated with the In Touch EMR™ software.

Practitioners using an EMR with cloud computing are ready for In Touch EMR™.

One EMR, Multiple Devices

In Touch EMR™ can be used with an iPad, Android tablet, computer or laptop. In Touch EMR can be implemented on Windows, Apple and Android operating systems.

In the beginning, practitioners may feel uncomfortable or self-conscious using voice recognition capabilities.

Clinicians who have never used an EMR before may want to use a computer or laptop when they first begin using voice recognition.

Laptops and computers provide practitioners with the flexibility to type or use their voice when documenting patient records.

For clinicians who are familiar with EMR usage, have little background noise, and are in a semi-private setting, an iPad or other tablet makes sense.

Clinicians can combine voice recognition and typing for documentation.

Implementing In Touch EMR software on mobile devices means practitioners attain greater portability, but typing will be compromised due to smaller screen size.

Accelerated Productivity

Combining the use of voice recognition with In Touch EMR™ increases the speed at which patient documentation can be recorded for increased productivity.

Voice recognition dramatically decreases the time and cost associated with transcription and billing processes.In Touch EMR

In In Touch EMR, Practitioners can dictate notes, edit, make referrals, document the entire patient encounter, and monitor follow up measures simply by talking.

It’s much easier, faster and efficient to speak than write/type.

In Touch EMR™ provides the means for clinicians to work more efficiently and quickly complete claims for billing.

Voice recognition capabilities allow clinicians to streamline all the office processes, document faster and spend more time with patients.

In Touch EMR™ provides a powerful tool that integrates easily with virtually any system. Combined with voice recognition usage, it simplifies life, completes documentation in a fraction of the time, and allows practitioners to submit claims faster.

Automating Appointment Reminders With Your EMR

Automating Appointment Reminders With Your EMR

Automated patient reminders are critical for practices and an EMR can handle that job, freeing staff for other, more important work. No shows, cancelations and rescheduled appointments interrupt the normal flow of patients and result in lost revenue.

EMREvery clinician should have a cancellation policy in place that indicates the practice needs at least a 48 hour notice to cancel.

Patients get busy and forget, but they have to know that there will be repercussions for cancelling.

Clinicians must be careful what the penalty will be, however.

Cancellation Consequences

Many practices charge patients at least 50 percent of the office visit cost. Patients will quickly become angry with this approach and may choose to take their business elsewhere, something that no practitioner wants.

Instead, the cancellation policy could stipulate that the patient will be required to donate $20 to a charity.

How Reminders Work

Twenty-four hours before the appointment, the EMR should send an email or text reminder to the patient.

It should address the patient by name, identify the practice, state that the message is a reminder of their appointment, and give the date and time.

If the patient wants to reschedule, they know how to contact the clinic.

Stick with the basics.

The same can be done with a phone reminder.

Patients can press one to confirm their appointment and the office does nothing. If a patient wants to reschedule or cancel, they can press two and the call will be routed to the office.

This allows the front desk to speak with them directly for patient retention.

Automating With An EMR

The In Touch EMR™ contains the ability to produce automated patient appointment reminders via email, text and phone.

The system can transfer reschedules and cancellations directly to the office. It integrates smoothly with existing office systems and clinicians can customize their messages.EMR

Automated patient reminders prevent missed revenues and overbooking, and can be utilized to remind patients when it’s time for an annual check-up or follow up visit. 

Clinicians can set reminders to notify patients about tests and other procedures that are conducted on a regular basis.

It’s just one of the ways that the In Touch EMR™ demonstrates meaningful use.

Having an automated system of patient appointment reminders is critical for clinicians. It eliminates manual effort, maximizes patient retention and reduces the work load on the front desk. It frees staff to perform insurance verifications, follow up on referrals, and conduct customer service tasks.

Common Myths About the KX Modifier and the Role of EMR

Common Myths About the KX Modifier and the Role of EMR

We get a lot of questions from billers, therapists and front desk people asking if the In Touch EMR™ system tracks the KX modifier and Medicare caps.

EMRThere’s no way any EMR system can do that.

The Medicare cap is shared with multiple professionals and the software has no way of knowing if a patient has seen another provider.

Tracking Medicare Caps

Clinicians can track the Medicare cap on a specific patient on the Medicare website. It’s the only accurate way of monitoring when a patient has neared his/her financial cap.

There’s no available EMR system that can track the Medicare cap, despite what vendors say. It’s not that they’re being deliberately misleading. It’s that they simply don’t know.

The In Touch EMR™ Difference

With the In Touch EMR, Medicare caps are handled differently. Clinicians monitor the caps of their patients to determine when it’s met or exceeded.

At that point, practitioners call In Touch EMR™ and the system is told to amend the KX modifier, which it does from that point going forward.

The KX Modifier

Medicare places an annual cap on the reimbursement amounts that it will pay for each patient’s physical therapy needs. That amount was $1,900 in 2013 for combined services of physical therapy and speech pathology.

Another $1,900 was allotted for occupational therapy.

The KX modifier is used for Part B claims when the cost for services exceeds Medicare’s financial cap, while meeting the exceptions process.

The KX modifier is also used when performing gender specific therapy. Its use notifies Medicare that it may need to examine a claim for editing.

EMRPayment is generally made, providing that clinicians have met and maintained the stringent documentation required to prove medical necessity.

It’s important to note that even with pre-approval, there’s no guarantee that reimbursements will be made.

It’s critical that clinicians understand the limitations and abilities of their EMR.

While no EMR can monitor the Medicare cap on a specific patient, Medicare maintains a running tab on each beneficiary and practitioners can use the site to ascertain the cap of any patient.

Once that information has been determined, the In Touch EMR™ can be told and the appropriate functions activated, making the billing process easier and more efficient for clinicians.