Q/A: Modifier -GA and automatic denials
APCs Insider, October 22, 2010
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Q: Is CMS still denying all line items with modifier -GA?
A: CMS has reversed the processing of line items with modifier –GA and will no longer automatically deny the line item according to Transmittal 770 issued September 17. Appending modifier -GA indicates the provider issued an advanced beneficiary notice (ABN) to the patient for the item.
In Transmittal 1840 issued October 29, 2009, CMS stated that, the institutional claims systems would automatically deny lines with modifier –GA, effective April 1, 2010. However, the automatic denial process did not allow Medicare contractors to review the line item to determine if the billed diagnosis supported the test
CMS’ suspension of the automatic denials is retroactive to April 1, according to Transmittal 770. However, the implementation date of the transmittal is October 17, which means that the edit was not corrected in the system until this date; therefore, contractors would have denied a line item with modifier GA up until that date.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
-
Modifier -59 Case Studies: Clarify Common Coding Confusion
Modifier -59 is a perennial problem area for outpatient coders. It shouldn’t be viewed as a way to guarantee payment but...
-
Outpatient Bed Charge Capture: Billing for Common and Complex Cases
During this 90-minute audio conference, our expert speakers walk you through common and complex cases and explain compliant...
-
Billing No-Cost and Low-Cost Devices: Tips to Avoid the Audit Fast Track
During this 90-minute audio conference, our speakers will use a case study to demonstrate best practices to help you comply...
-
Spinal ICD-9 and CPT Coding
During this two-hour audio conference, our speakers will discuss common coding errors for spinal diagnoses and procedures...
-
2012 OPPS Final Rule: Analyze the Impact and Manage the Changes
Expert speakers Jugna Shah, MPH, and Valerie A. Rinkle, MPA, return for this popular program. They review the final rule...
Most Popular
- Articles
-
- Recent Recovery Auditor activity
- Note from Hugh
- Depressing Leapfrog scores haunt hospitals
- The week in Medicare updates
- Where patient rights and patient safety meet
- Q/A: How should we report irradiated blood products?
- Applying multiple procedure payment reductions to therapy cap amounts for Critical Access Hospital (CAH) claims
- Wife of slain coach: Is HIPAA privacy more important than a life?
- 2014 SNF Proposed Rule Analysis: Revising and rebasing the SNF market basket
- Advanced practice nurses shouldn’t be left behind in meaningful use journey
- E-mailed
-
- Applying multiple procedure payment reductions to therapy cap amounts for Critical Access Hospital (CAH) claims
- Georgia hospitals scrambling to create residency positions
- Q/A: How should we report irradiated blood products?
- CMS looking for comments on molecular pathology payments
- Don't burn those ICD-9-CM Manuals just yet
- Q/A: Should we report low-level E/M for all infusion patients?
- Tip of the week: Build a successful website to impress candidates
- Joint Commission seeks input on behavioral health home certification
- Report: Nearly 10 percent of patients have C.diff at admission
- Wife of slain coach: Is HIPAA privacy more important than a life?
- Searched