Updates from Cahaba on RHC Claims

Nov. 29, 2016

ALL RHC Medicare claims – whether “single line” or “multi-line” MUST have the CG modifier on the “pay” line. If a single line, the CG modifier goes on the single line with the HCPCS code for that RHC visit.

If multi-line, then the CG modifier goes on the line (typically the line that is the principle reason for the visit) on which you have rolled up all of the charges for the encounter.  This lets CMS know that this is the line on which they should base the beneficiary co-insurance.

If you had claims rejected because the claim did not have the CG modifier, then you will need to re-file the claim.  Here is a link to the instructions for re-filing a Cahaba claim: http://www.cahabagba.com/documents/2012/02/part-a-fiss_correct.pdf

Bill Finerfrock

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