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ABN & Medicare Advantage

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  • Melinda
    Hello Forum! I could use your help. I have a Medicare Advantage Plan who is new to the Advantage playground as of 1/1/10. They are telling me that I cannot
    Message 1 of 3 , Sep 1, 2010
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      Hello Forum!

      I could use your help. I have a Medicare Advantage Plan who is new to
      the Advantage playground as of 1/1/10. They are telling me that I
      cannot use a Medicare ABN for notification to a patient on a
      "potentially cosmetic procedure" that may be non covered.

      The patient was in for:
      99214-25, dx: 401.1, 380.4 17110-GA dx: 702.19. We had the patient
      sign an ABN for the lesion removal and I billed with GA modifier to
      indicate that. They denied both the office visit and the lesion
      removal. I am working with my provider rep. to discover why they didn't
      pay the E/M and why I cannot bill the lesion removal to the member.
      Has anyone experienced it with other Advantage Plans? What are we
      (providers) supposed to do in this situation? Any insight you can
      provide me with would be greatly appreciated. Melinda Brown, CMBS
      Ins Biller


      [Non-text portions of this message have been removed]
    • djgeisel
      In our office we do use the ABN on Medicare non covered services for plans that we are par with. For a commercial carrier we cover this in our financial
      Message 2 of 3 , Sep 3, 2010
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        In our office we do use the ABN on Medicare non covered services for plans that we are par with. For a commercial carrier we cover this in our financial statement which they sign when they come in on the first new patient visit.
        Diana


        --- In MedicalBillers@yahoogroups.com, "Melinda" <melindadocsmith@...> wrote:
        >
        >
        > Hello Forum!
        >
        > I could use your help. I have a Medicare Advantage Plan who is new to
        > the Advantage playground as of 1/1/10. They are telling me that I
        > cannot use a Medicare ABN for notification to a patient on a
        > "potentially cosmetic procedure" that may be non covered.
        >
        > The patient was in for:
        > 99214-25, dx: 401.1, 380.4 17110-GA dx: 702.19. We had the patient
        > sign an ABN for the lesion removal and I billed with GA modifier to
        > indicate that. They denied both the office visit and the lesion
        > removal. I am working with my provider rep. to discover why they didn't
        > pay the E/M and why I cannot bill the lesion removal to the member.
        > Has anyone experienced it with other Advantage Plans? What are we
        > (providers) supposed to do in this situation? Any insight you can
        > provide me with would be greatly appreciated. Melinda Brown, CMBS
        > Ins Biller
        >
        >
        > [Non-text portions of this message have been removed]
        >
      • Melinda
        Thanks Diana!
        Message 3 of 3 , Sep 3, 2010
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          Thanks Diana!
        Your message has been successfully submitted and would be delivered to recipients shortly.