Modifier Rules, Audit Prep & Practice Wins

As May begins, it's a good opportunity to review your systems and stay current with payer requirements. This week’s update includes practical tips to reduce no-shows, prevent claim denials, and improve day-to-day operations

🛠️ Practice Tip: Lower No-Shows by 30%

Want to boost attendance? Add text message reminders with confirmation links 24 hours before appointments. According to a recent APA study, clients who confirm via text are 30% more likely to show up.

🏥 Medicaid Trends to Watch

We’re seeing an increase in claim denials related to telehealth and incorrect modifier usage. Here's what to double-check:

Passport Molina: Always use Modifier 95 in the second position for telehealth.

General Rule: Use the appropriate modifier for your licensure type in the first position (e.g. U4, HO, AJ).

🔍 Refer to the KY Behavioral Health Fee Schedule to confirm the appropriate modifier for your licensure type.

📋 Compliance Tip:

Review your EHR for incomplete treatment plans and expired consent forms. These are common red flags during audits and can delay authorizations.

🧾 Practice Management: Mid-Year Check-In

If you’re running a group practice, May is a great time to:

✅ Audit supervision logs

✅ Update staff credential & scope documentation

✅ Clean up treatment plan deadlines

✅ Conduct a credentialing & billing audit

Need help training your team or cleaning up processes? Just reply to this email or book a free 15-minute consult.

📌 CPT 90887 – Quick Collateral Therapy Reminder

When billing for behavioral health consultations with caregivers or school staff:

• Must be tied to the client’s treatment plan

• Must involve someone with custodial supervision

• Consent is required if not the legal guardian

🔗 Review KY Medicaid Guidelines

We help individual providers and group practices with credentialing, billing troubleshooting, and practice management. Let’s make your systems stronger together.