Wiki ABN with G0101 and Q0091

[bbernardin]

Is is necessary to get an ABN signed when it is the year that the patient is qualified for payment of these services? Also, is it ok to have an ABN signed every year even if the patient is eligible for payment on these services the year they come in? If the patient is eligible for payment and they do not sign an ABN is the GZ modifier required or can this be billed without a modifier and payment still be received?

 

[OBcoder2017]

Is is necessary to get an ABN signed when it is the year that the patient is qualified for payment of these services? Also, is it ok to have an ABN signed every year even if the patient is eligible for payment on these services the year they come in? If the patient is eligible for payment and they do not sign an ABN is the GZ modifier required or can this be billed without a modifier and payment still be received?

I believe it is the "best practice" to get a signed ABN every year. The time that is involved in determining if the exam was or was not paid could be a factor; it is also possible that the patient has gone elsewhere. In addition, outside labs may request a copy of the ABN you have on file. As far as the GZ modifier, this would be for use if the patient indicates on the ABN that they want you to go ahead and bill Medicare even though you are expecting a denial. Some patients want to make sure that Medicare will not pay and like to get their eob in the mail confirming that. Others will say they do not want Medicare billed for the year that their exam is not payable. They will mark this on their ABN.