Q/A: Modifier -GA and automatic denials
APCs Weekly Monitor, October 22, 2010
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
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 Weekly Monitor!
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
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Topic: CMS, OESS post new security compliance review information, checklist
- HIPAA Q&A: Level of encryption needed for email
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- Catch up on what's new with injections and infusions
- CMS has reformulated payments for some bilateral procedures
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- What does case-mix index mean to you?
- ED-to-inpatient transfers are flawed with safety gaps
- Searched