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tci Medicare Compliance & Reimbursement - 2013 Issue 12

Claim Denials: Brace for Intensified Scrutiny of 'G' Modifiers

Without standardized procedures, Medicare has overpaid almost $744 million in 2011 alone. The HHS Office of Inspector General (OIG) wants to stop inappropriate payments when MACs allow claims which have a ‘G’ modifier. Read on for the skinny on what’s being targeted. Refresher: The G modifiers are meant to indicate that a denial is expected, which actually paves the way for alternate payments in many cases. On May 3, the OIG sent the Centers for Medicare & Medicaid Services (CMS) its report entitled Medicare Payments for Part B Claims With G Modifiers, which revealed that MACs often...

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