Got FAQs?
By Lisa Lake-Salmon  The future of your practice depends on
knowledgeable billing and collection information. Understanding the
full aspect of billing guidelines and procedures will effectively
increase your reimbursement. This informative column will help
providers and their staff with a better understanding of billing
procedures and reimbursement strategies.
Q: Can you please clarify when I would use the GA
modifier, as opposed to the GY modifier, when billing a claim to
Medicare?
A: The GA modifier should be used when you
expect Medicare to deny your claim as not reasonable and medically
necessary. You must obtain a signed Advanced Beneficiary Notice
(ABN) from the patient. The GY modifier should be used to receive a
correct denial for items that are ineligible or do not meet the
definition of any Medicare benefit.
Q: After Hurricane Katrina, I was notified by a patient
whose brace was destroyed during the storm. I have provided the
patient with another brace, but need to know if Medicare will pay
for the replacement.
A: Yes, Medicare will pay for another brace.
You will need to file a hardcopy claim with documentation stating
the nature of the disaster and the damage the brace suffered. At
the top of the claim form, indicate in large bold letters,
"Disaster Claim" and the nature of the disaster, e.g., hurricane
claim.
Q: I know that Medicare will allow only one orthosis
every five years for a patient. I currently have a patient who has
an orthosis that I provided over three years ago. The patient's
medical condition has changed, and modifications need to be made to
the orthosis. How do I go about billing Medicare for these changes?
Will Medicare reimburse for these changes?
A: According to DMERC, the reasonable lifetime
of an orthosis is five years. If the patient's medical condition
significantly changes and necessary adjustments to the equipment
are needed, the provider is required to submit all updated medical
changes along with the claim. Replacement due to wear is not
covered during the reasonable useful lifetime of the equipment.
We invite readers to ask questions you have regarding
billing, collections, or any other information. To send your
questions or for more information, contact: lisa@weternmediallc.com
Acc-Q-Data provides billing, collections, and practice
management software serving the O&P industry nationwide for
over a decade. Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc. 
Table Of Contents - November 2005
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