tci Part B Insider - 2013 Issue 17

MACs Will Soon Be Scrutinizing 'G' Modifiers on Part B Claims

Whether you’re reporting GA, GX, GY or GZ, know that Medicare is watching closely. Medicare’s “G” modifiers—which inform your contractor that you expect a claim denial—are quite handy in a variety of situations. But these modifiers can also lead to incorrect payments, and the OIG wants that to stop. On May 3, the OIG sent CMS its report entitled Medicare Payments for Part B Claims With G Modifiers, which revealed that MACs often do not “specifically check claims for which providers expect not to be paid,” leading to inappropriate Part B payments...

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