Is your practice utilizing the Advanced Beneficiary Notice of Noncoverage (ABN) correctly?

The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by Medicare or considered medically necessary.  Now that we have established when to use an ABN, the following providers should be giving them out: doctors’ offices, providers (including laboratories), practitioners, suppliers, and skilled nursing facilities (SNF) when services may denied under Part B.   ABNs are not required in an emergency situation.

Not only do providers need to make sure they are providing ABNs appropriately, but they need to use the correct version.  As of January 1, 2012, any ABN forms with a release date of 03/2008 (in the lower left hand corner) are considered invalid with CMS, so if you have any stock piles of these forms, get rid of them.  Make sure that you are using the ABN form with the release date of 03/2011 which became mandatory as of 1/1/12.

Since we have reviewed the basics of the ABN, here are a few tips on the billing process when submitting a claim with an ABN.

  • Modifier GZ is used when providers expect Medicare will deny a service or item and they don’t have an ABN signed by the patient.
  • All claims with modifier of GZ will be denied automatically & not subject to complex medical review.
  • Modifier GA is used when providers expect Medicare will deny a service or item and they do have a signed ABN.
  • Failure to report modifier GA could result in your assuming financial responsibility for denied service or item.

If you have any other questions, need additional information on the ABN process, or want to download the newest version of the form, visit the CMS website or for more info on the modifiers visit the FCSO website.

This entry was posted in Coding & Billing and tagged , , , , , , . Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *