October 15, 2013
A large number of Medicare Carriers lost contracts bringing new Medicare Carriers in several states. If you are in a state with a new Medicare Carrier, be aware of the “Local Coverage Determination” (LCD) changes. CMS delivers the guidelines, however, the Medicare Carriers can produce their own Local Coverage Determinations (LCD) that can have a major impact on your practice. Especially if you are unaware of the changes.
An Example:WPS Medicare Carrier in Illinois lost their contract to National Government Services (NGS). WPS followed the ABN guidelines as presented by CMS. However, NGS Carrier has indicated that we cannot use the “AT” and “GA” modifiers together. This indicates to them that the patient signed the ABN indicating this adjustment was “maintenance care” which is a non-covered service, and will automatically be denied payment.
If this is true....the doctor has lost the ability to financially protect themselves if a covered service is denied by Medicare.
***** So...be sure to visit your Medicare Carrier’s web site, register for webinars and special training presentations. Most carriers have a free service (NGSConnex for Illinois) where you can check eligibility, submit claims and appeals, and obtain financial information.