Anyone who’s ever filled out an advance beneficiary notice (ABN) for a Medicare patient knows what the GA modifier is. This modifier tells Medicare payers that an ABN is on file for a service that the insurer doesn’t cover. And as of February 1st, it will also do the same for UnitedHealthcare (UHC) commercial plans.
UHC announced the change on Sept. 1, and now that its GA modifier effective date is approaching, it’s a good time to master the specifics. Check out three facts on how to comply.
1. You May Need to Educate Patients
Medicare beneficiaries may be quite familiar with signing ABNs, but that isn’t necessarily true of patients on commercial plans. If you have a UHC patient who is getting a non-covered service or item, you’ll need to let them know it probably won’t be covered. You should ask them to sign an ABN or a similar document outlining how much they may owe and why you think the service might be denied. The patient can then sign the waiver of liability and you can append the GA modifier (Waiver of liability statement on file) to the claim.
If patients ask what the reason is that they need to sign the form, you can let them know it’s expected to provide them with greater transparency so they can decide whether or not they want to move forward with the item or service once they know the potential cost.
2. You’ll Need to Inform Your Team
To ensure you give the ABN to every patient who needs it — Medicare, UHC and others — you’ll need to inform your staff members about who should get the document.
You should also educate your billing and coding staff about how important it is to append the GA modifier to your claims when you do have the ABN on file. If the patient doesn’t sign the document and you don’t append modifier GA to the claim, you can’t bill the patient if it gets denied.
3. Save All Documentation
It’s important to retain your ABNs for all patients, including those who are insured by UHC. If you submit the GA modifier on a claim, an auditor would expect you to be able to support it by producing the estimate that you had the patient fill out (the ABN or a similar document).
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