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Do: Verify if the medication is separately reimbursable Use the appropriate modifier when needed (e.g., Modifier 25) Ensure documentation supports medical necessity Dont: Bill 96372 without a corresponding diagnosis code Assume its bundled unless mentioned in the payers policy Forget to link the drug (e.g., J codes) with the injection When in doubt, this is where smart revenue cycle management healthcare practices step in

In contrast, many solo practitioners who do not submit data do so despite not being eligible for application of our reweighting policies or not applying for reweighting under those policies

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