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Conditional Modifiers Setup

Additional modifiers needed for other billing purposes.

This setup allows users to add, edit, or delete Modifiers that can be used for different Payers, different Modifier sections, and Modifier Numbers to match what a specific payer requires.

These modifiers can be added to a bill in data entry on the Charges Tab.

Some valid modifiers include:

GM: Multiple Patients on one ambulance trip

QL: Patient pronounced dead after ambulance called (do not use any other modifiers)

CR: Catastrophe/Disaster Related (include origin and destination modifiers)

GA: Waiver of liability (Advance Beneficiary Notice or ABN) statement on file

GW: Service not related to the hospice Patient’s terminal condition

GY: Item or service is statutorily excluded or does not meet the definition of any Medicare benefit

Use the modifier GY to report ambulance services for patients whose conditions do not meet the requirements for coverage, or for whom ambulance transportation is not covered.

GZ: Item or service expected to be denied as not reasonable and necessary

It is considered inappropriate billing if an ambulance provider uses a modifier that does not describe the origin/destination. For example, if a patient is taken from his residence to the physician’s office in the professional building at the hospital, this transfer should be billed with R for residence and P for physician’s office.

Add: A new value can be added to the list using the plus button on the top right.

When Add is selected, it opens the data entry for adding a new value. The Description, Modifier, Modifier Section(s), and Modifier Number sections must be filled out completely for the Save and Save & add options to be active. Once the value is entered, select Save to add the value to the list or Save & Add to add the value to the list and add more.

Selecting Cancel will take the user back to the Quick Pick list of values without adding a new value.

Payer(s) Section: Add a payer or payer type in this section for a Conditional Modifiers record in order to auto-populate that conditional modifier whenever that payer is selected.

Configuring a Conditional Modifier for the Mod 1 position will cause the Conditional Modifier to auto-populate, overwriting any modifier currently in the Mod 1 position that might've auto-populated from Modifier 1 Setup. 

However, if the transport locations aren't yet entered when the Conditional Modifier is populated, or the transport locations are updated after the Conditional Modifier populated, the Modifier from Modifier 1 Setup will overwrite the Conditional Modifier. 

Keep in mind that when working a bill for a payer that has a Conditional Modifier, the Transport Tab should be completed before the Payers/Charges Tabs.

Filter: To narrow the results of a list, begin typing the description you are searching for.

Actions:

Edit: If changes need to be made to an entry, use the edit button.
Delete: Remove an existing entry.