Improvement

Advance beneficiary notice

How to get paid for Medicare non-covered services

Advance beneficiary notice (ABN) is the mechanism for ensuring that you can bill a patient for Medicare non-covered services. There are several different non-covered categories, however, the most common are services that are never covered by Medicare, and services that are not covered by Medicare for a particular diagnosis or frequency of services (determined by Medicare to be not medically necessary).

By providing the patient with advance notice, you avoid providing services that cannot be billed to the patient. You also set up an expectation of payment with the patient requesting or requiring non-covered services. The advance notice is a statement that the patient signs confirming their understanding that the service is not, or may not be covered. Go to www.cms.hhs.gov/medicare/bni/ for a downloadable form, see CMS-R-131-G.

Non-covered services need not be billed to Medicare; you are entitled to collect at the time of service for the full fee. Services that are covered by Medicare and may not be covered for this patient/circumstance must be billed to Medicare with a “GA” modifier to indicate that you have a signed ABN on file. Please note the GA modifier on your encounter form for any services requiring notice.