Resolved The New ABN

[ElisM_57758]

Hello,

Currently the ABN triggers for MFFS (Medicare Fee For Service) with the New ABN the waiver applies to a patient who has Medicare as primary and Medicaid as secondary. When we have a valid ABN on file after 8/31/2020 will be be appending a GA for that Medicaid claim also? Currently at my facility the NONC triggers and we do not append any modifier indicating the NONC status. If the ABN is now duel for a patient who has both Medicare and Medicaid then wouldnt we appened a GA and bill to Medicaid for those services failing medical necessity? thanks

 

[Jennifer]

The GA modifier would still be necessary. That is how MC will know to process the claim as patient liability. If the patient has the MA set up as a medigap/automatic cross over, then the claim will go to MA with that denial. They too should deny, depending upon the state requirements for the medical assistance claims and applicable modifiers (such as: our state would not allow that modifier - only a handful are acceptable if we billed it ourselves. Crossovers are different.)
After 8/31/2020 they should both deny, assuming the state assistance plan has taken the modification into account timely. Then the provider/facility can determine if they want to as the patient to be responsible. (I know some states are inundated right now with unemployment and COVID claims and may not have updated their systems for many changes.)
Did that answer the concern?

 

[ElisM_57758]

yes thank you again for answering my question