Novice Know How - The GA Modifier
The purpose of an Advance Beneficiary Notice (ABN) is to inform a Medicare patient, before he/she receives an item or service that otherwise might be paid for, that Medicare certainly or probably will not pay for it on that particular occasion. The ABN allows the patient to make an informed decision whether or not to receive the item or service for which he or she may have to pay for out of pocket.
If a provider believes Medicare may deny a service or item as not medically necessary, he/she should present the patient with an ABN and submit the claim to Medicare using a GA modifier.
Usage of routine or blanket ABNs is not an acceptable practice. Routine means presenting an ABN where there is no specific, identifiable reason to believe Medicare will not pay. A blanket ABN means presenting an ABN for all items or services provided.
The GA modifier indicates an ABN was presented to the patient and is on file in the office. The patient has signed the ABN acknowledging the possibility of Medicare's denial. If Medicare determines the service is not payable and denies the claim with a medical necessity denial, the denial message will indicate that the patient is liable for the charges. A patient cannot refuse to sign an ABN and expect to have his/her financial liability waived. If the patient or his/her representative refuses to sign the ABN, the provider can still bill the patient (on assigned claims only), if the following items are documented and available if requested by Medicare:
- Date of refusal to sign,
- Who refused to sign (patient, his/her representative, etc,),
- Who witnessed the refusal and the signature of the witness and
- The services and the date of service as noted on the ABN.
Medicare will review the claim like any other claim and may or may not deny it. Medicare does not use the presence of the GA modifier to influence its determination of coverage and payment of the service.
Do not submit a copy of the ABN with the claim; however, keep a copy in the patient's file in case Medicare requests it.
You can find additional information about the ABN and the location of the ABN form by clicking here.
Page Last Updated: Wednesday, 30-Dec-2009 10:43:35 CST
