CG Modifier & Cahaba

Nov. 23, 2016

As many of us know, beginning October 1, most RHC Medicare claims (with a few exceptions) were required to have modifier CG on the claim. While we (the NARHC) communicate billing updates through this listserv as soon as we learn about them, this is ultimately a responsibility of each MAC to communicate these updates to their jurisdiction.

NARHC staff has discovered that Cahaba did a very poor job of communicating the Oct. 1 CG changes to their providers. A significant number of RHCs in Cahaba’s jurisdiction were completely unaware of the CG modifier changes. Making matters worse, Cahaba’s customer service department was also not aware of these billing changes, even though their IT department had updated their system per the Oct. 1 guidelines.

As a result, RHCs that were oblivious to the CG modifier changes started calling Cahaba and inquiring why their claims were being denied. Unable to accurately diagnose the problem (that there was no CG modifier on the claims), Cahaba’s customer service department began telling people that it was a “system” problem on Cahaba’s end and that they were working on a fix.

NARHC staff has confirmed with CMS central staff that this is not a problem with the FISS or some other Cahaba system, but rather a severe lack of communication within Cahaba, and to Cahaba providers, around the CG modifier changes.

The good news is that CMS and Cahaba realize the true nature of the problem now, and we have been told that Cahaba is actively working on getting all their departments on the same page here. We have made it clear that Cahaba needs to detail specific instructions on how RHCs should refile the claims that were rejected for not following the CG rules. We anticipate that Cahaba will issue a correction soon that explains their oversight and properly educates their RHC providers on the CG changes.

Nathan Baugh
NARHC Director of Government Affairs
(202) 544-1880
Baughn@capitolassociates.com

Views – 187

Posted by admin in Uncategorized
Join now