How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
In one word — modifiers. Modifiers are the best way to communicate this information to the payer. As an example, if the patient’s primary payer was Medicare and you know that their secondary policy covers a service that Medicare does NOT cover when provided in a chiropractic office (e.g., electrical stimulation, x-ray), then you would include modifier GY to indicate that it is a noncovered service. Keep in mind that there may be other modifiers which would also need to be added to the procedure code on the claim (e.g., GP, GX).
Note: Please see “Medicare Modifiers” beginning on page 115 of the 2020 ChiroCode DeskBook for more comprehensive information on using these modifiers.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.”
So what are those requirements?
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.
Implants could be considered ...
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...