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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.

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