Is all this correct???
GZ - an ABN should have been signed, but wasn't. Medicare denies and you cannot bill patient
GY - a non-covered (excluded service) that you are submitting for a denial EOB only. (this non-covered can also be charged to patient and you do not have to send claim to medicare)
GA - you are doing a covered procedure for a non-covered DX you have to get an ABN and use the GA or you have to write it off. You can bill patient if service is denied.
Is it wrong to continually bill services to Medicare that we know will not be covered, without any type of Modifier? Say a certain office states they are too busy to deal with ABN, so they continually submit claims to MCR that are denied as not covered, or not medically necessary.(losing big time money!!)
and someone else says this can cause a red flag to MCR, maybe indication that we are not following or don't know guidelines. (any truth to that-the "red flag" part)
Thanks!
GZ - an ABN should have been signed, but wasn't. Medicare denies and you cannot bill patient
GY - a non-covered (excluded service) that you are submitting for a denial EOB only. (this non-covered can also be charged to patient and you do not have to send claim to medicare)
GA - you are doing a covered procedure for a non-covered DX you have to get an ABN and use the GA or you have to write it off. You can bill patient if service is denied.
Is it wrong to continually bill services to Medicare that we know will not be covered, without any type of Modifier? Say a certain office states they are too busy to deal with ABN, so they continually submit claims to MCR that are denied as not covered, or not medically necessary.(losing big time money!!)
and someone else says this can cause a red flag to MCR, maybe indication that we are not following or don't know guidelines. (any truth to that-the "red flag" part)
Thanks!