Coverage for a service or item may be allowed only when documentation supports the medical need for the service or item. In cases where the provider believes that the service or item may not be covered as medically reasonable and necessary, an acceptable advance notice of Medicare s possible denial of payment must be given to the patient if the provider does not want to accept financial responsibility for the service or item. The signature of the provider of service is not required. The advance notice form should be maintained with the patient s medical record. Failure to report modifier GA in cases where an appropriate advance notice was given to the patient may result in the provider having to assume financial responsibility for the denied service or item.
Every clinic has the waiver available.
The list of non-covered services is updated regularly in the Medicare Part B Updates. If you do not have access to the Updates please contact your Facility POD Associate. The Newsletter is dependent upon your contributions. Items regarding education, research, and clinic activities are welcome. You are encouraged to submit articles to the Newsletter editor by the 14 th of the month.