Advance Beneficiary Notice for Physicians - An Overview - PowerPoint PPT Presentation

Loading...

PPT – Advance Beneficiary Notice for Physicians - An Overview PowerPoint presentation | free to download - id: 88cf72-MjJkY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Advance Beneficiary Notice for Physicians - An Overview

Description:

An Overview of Advance Beneficiary Notice for Physicians - Awareness about when and when not to issue an ABN form is vital for doctors. – PowerPoint PPT presentation

Number of Views:3

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Advance Beneficiary Notice for Physicians - An Overview


1
Advance Beneficiary Notice (ABN) for Physicians
an Overview
www.outsourcestrategies.com
1-800-670-2809
2
  • Advance Beneficiary Notice of Non-coverage (ABN)
    is a form from CMS (Center for Medicare and
    Medicaid) that providers can give their patients,
    if they believe that Medicare will deny payment
    for a service because it is not medically
    necessary.
  • The issuing of ABN form allows the beneficiary to
    make an informed decision about whether to get
    the service that may not be covered and accept
    financial responsibility if Medicare does not
    pay.
  • Professional medical billing companies can assist
    physicians with their billing, coding and claim
    submission tasks, but it is important for
    physicians to have a clear idea regarding
    Medicares Advance Beneficiary Notices (ABN) and
    whether or not to issue the form before providing
    any service.

www.outsourcestrategies.com
1-800-670-2809
1-800-670-2809
3
  • ABN Two Types
  • Required ABN - for the service that is a benefit
    of Medicare but not paid due to restricted
    coverage
  • Voluntary ABN - for the service that is not a
    benefit of Medicare, which is never payable

www.outsourcestrategies.com
1-800-670-2809
4
  • ABN Can Be Issued, If
  • They believe Medicare may not pay for an item or
    service
  • The patient is not terminally ill, and
  • The service provided is not medically reasonable
    and necessary for this beneficiary

www.outsourcestrategies.com
1-800-670-2809
5
  • ABN Cannot Be Issued
  • If the provider does not have a specific reason
    to believe the service will be denied
  • After the exam has already been performed, or
    when the patient has already been prepped and
    is about to begin the exam
  • To make the patient pay for a bundled service
  • If it is an emergency situation

www.outsourcestrategies.com
1-800-670-2809
6
  • Use the Right Modifier
  • The claim must be noted with the correct
    modifier.
  • GA modifier is used to issue a mandatory ABN for
    a service as required and it is on file.
  • GX modifier is used to issue a voluntary ABN for
    a service Medicare never covers as it is
    statutorily excluded, or is not a Medicare
    benefit.
  • Use GY, if the service is not a benefit of
    Medicare in any definition. It can be billed in
    combination with GX if the patient signed an ABN
    and is liable.
  • GZ is used for service that is expected to be
    denied and an ABN was not issued and beneficiary
    is not liable.
  • ABN guidelines can be referred in detail in the
    CMS booklet on Medicare Advance Beneficiary
    Notices.

www.outsourcestrategies.com
1-800-670-2809
7
Contact Us
Headquarters8596 E. 101st Street, Suite
HTulsa, OK 74133Main (800) 670 2809
www.outsourcestrategies.com
1-800-670-2809
About PowerShow.com