June 10, 2009
CIGNA Government Services to End Corrections for Incorrectly Billed Capped Rental Modifiers (KH, KI, and KJ)
CIGNA Government Services has identified an increase in billing errors related to the inappropriate use of the capped rental "K" modifiers. During our review of "K" modifier usage, it was determined that many suppliers use the same modifier on each monthly billing and rely on CIGNA Government Services to correct billing errors. Effective with claims received on or after August 10, 2009, we will no longer provide corrections and will deny claims that are not billed with the appropriate "K" modifier with ANSI reason code 182, remark code N56.
When billing a capped rental item or a PEN Pump, the "KH" modifier shall only be used for the first month of billing. The "KI" modifier shall only be used for the second and third months of billing. The "KJ" shall then be used for the remainder of the capped rental period. CIGNA Government Services offers an online "Modifier Finder Tool" which can assist you in determining the correct usage of these modifiers. The tool can be found at: www.cignagovernmentservices.com/medicare_dynamic/modifiers_dme/search.asp.
Additionally, if the capped rental item was previously provided to a Medicare beneficiary and a new rental period is now being requested, you must add a narrative that clearly explains why the item is being replaced to avoid unnecessary denials. We recommend that you use our Interactive Voice Response (IVR) system at 1.866.238.9650 to verify if equipment was previously provided. Effective with claims received on or after August 10, 2009, we will begin denying claims with modifier "KH" where a previous initial capped rental month is on file and the claim is submitted without a narrative that clearly supports a new rental period. These claims will deny with ANSI reason code 182, remark code N56.
If a denial is received due to either the incorrect billing of the "K" modifier or a missing narrative, correct the information and resubmit the claim. Claims billed with the correct "K" modifier and denied in error should be referred to reopenings.
