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Chiropractic Coding and Billing
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Medicare Modifiers, GA, etc.
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Re: Medicare Modifiers, GA, etc.
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Doo
Re: Medicare Modifiers, GA, etc.
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Sep 10 02 4:29 PM
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My Recent Posts
I believe in CYA (cover your ....), so I have all pts sign something if we expect it to be denied. This is NOT required. Lemme clarify.
We have two situations, "not reasonable and necessary" and "not a covered benefit".
Not Reasonable and Necessary: A service that is normally covered, but because of circumstances, expects to be denied as not reasonable and necessary. Pap smears every 2 months (pap smears are covered, just not this often); two office visits in one day (OV is covered, not this often); weekly psychotherapy for six months with a minor stress diagnosis, etc.
Not A Covered Benefit: A service that is never covered under any circumstances. Examples: Ear Piercing, House Cleaning by a Home Health Aide, Medical Care Performed by a Family Member, Plastic Surgery for Cosmetic Reasons, Removal of Skin Tags (with no symptoms), etc.
Use either GA or GZ for Not Reas. GZ means basically someone screwed up cuz you should have gotten the ABN signed. GA means you did it right.
Use GY for Not Covered. Although an ABN is not required, whenever a situation called for a GY modifier, we would have the patient sign our own version of the ABN, that states the services they have requested are, in our opinion, NEVER covered under their medicare plan, but that we will bill Medicare on their behalf, and because we expect it to be denied, they are fully responsible for the charges at the time of service. We incorporated the wording into the regular ABN so we would only have one form.
Sharon
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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Chiropractic Coding and Billing
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Medicare Modifiers, GA, etc.
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