L. Neal Freeman


Advance Beneficiary Notice shifts responsibility for payment

Based on a physician's knowledge of the risk of non-payment, Medicare's Advance Beneficiary Notice should be used when the physician believes the service is unlikely to be covered since it may not be medically necessary or reasonable. The ABN explains to the patient that even though Medicare does not pay for a certain item or service does not mean that the patient shouldn't have it. The –GA modifier should be used on the ABN. If –GA is not appended, the patient will be informed in the Explanation of Benefits that they are not responsible for payment.