puggles
Networker
OK here is the situation.......
Pt comes in for her yearly female exam, she is on Medicare. The office does not have her sign an ABN form. The office bills the following codes to Medicare.....99397 (no modifier) and G0101 (no modifier). Medicare eob comes back dening the 99397 for PR-204(not covered,pt resp) and the G0101for CO-119(max benefit). We then billed the claim to Anthem, but Anthem denied the whole claim since Medicare denied the claim. We then wrote off the G0101, but billed the patient for the 99397. Now is a carve out allowed on the 99397, even though Medicare did not pay for the codes billed? Can the patient be billed for the 99397 even if no ABN was signed??
Any advice would be really appreciated!!!
Thanks Alot
Miranda
Pt comes in for her yearly female exam, she is on Medicare. The office does not have her sign an ABN form. The office bills the following codes to Medicare.....99397 (no modifier) and G0101 (no modifier). Medicare eob comes back dening the 99397 for PR-204(not covered,pt resp) and the G0101for CO-119(max benefit). We then billed the claim to Anthem, but Anthem denied the whole claim since Medicare denied the claim. We then wrote off the G0101, but billed the patient for the 99397. Now is a carve out allowed on the 99397, even though Medicare did not pay for the codes billed? Can the patient be billed for the 99397 even if no ABN was signed??
Any advice would be really appreciated!!!
Thanks Alot
Miranda