Billing: Documentation

Advance Beneficiary Notices (ABNs)

  • A Laboratory may not bill a Medicare Beneficiary for a test unless it notifies the patient in writing before the testing is done that Medicare is not going to pay for the test. This notice is called an ABN.
    • Laboratories cannot make all Medicare beneficiaries sign ABNs.
    • The ABN must contain the specific name of the test and give a specific reason the laboratory thinks payment for the test will be denied.
    • The beneficiary should sign the ABN and a copy should be sent to the laboratory and one given to the beneficiary.
  • The billing department must have evidence that the ABN has been signed before it bills a patient.
  • A laboratory may bill Medicare even though it knows it will not be paid when it has evidence an ABN has been signed.
    • A modifier (GA) must be added to the CPT code for a test where an ABN has been signed.

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