When a Non-Covered Service Claim Gets Paid
February 22nd, 2023 - Ronald Hirsch
It happens more often than you might expect.
One topic I often speak about is patient notices. Don’t we all love them? We all know no one really reads them until something goes wrong, and then you better be darn certain you did it right.
Recently I discovered something very interesting about one of the outpatient service notices. If you provide an Advance Beneficiary Notice of Non-coverage (ABN) to a Medicare patient for an outpatient service that you have determined does not meet Medicare coverage guidelines and they sign it, agreeing to pay, the billers will place a -GA modifier on the claim – informing the Medicare Administrative Contractor (MAC) that the hospital does not feel this is a covered service, that the patient agreed to pay, and that a signed ABN is on file at the hospital.
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This article originally published on February 22, 2023 by RACmonitor.
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