ABN/Medicare Utilities Terminology
- ABN - Advance Beneficiary Notice (2 types – Lab Tests and Health Care Items or Services)
- LMRP - Local Medical Review Policy - statewide Medicare coverage and claim submission guidelines. Not all services have LMRPs
- NCD National Coverage Determination - nationwide Medicare coverage guidelines. Not all services have NCDs
- GA, GZ, GY- Medicare Modifiers that are appended to the CPT code to provide additional information about a service provided
- The GA modifier should be attached when an ABN has been captured for services which we anticipate may be denied by Medicare due to medical necessity.
- The GZ modifier should be attached when an ABN has not been captured for services which we anticipate may be denied by Medicare due to medical necessity.
- The GY modifier should be attached only to Medicare non-covered services.
- Misys System - Lab information system that interfaces lab charges to EPIC
- CRWQ 70 - Charge Review Work Queue, number 70. This work queue within EPIC – is where all the Interfaced Lab edits reside that need review and resolution before being released into the permanent Accounts Receivable (A/R)
- ABN Write-Off Report - This is a monthly report that shows by CPT Code, Scheduling Department and Provider, those services that were written off due to no ABN being captured
Please note that PBS Coding Staff are currently assisting with the review of CRWQ 70. They are also currently adding the Medicare modifiers to services that edit to CRWQ 70.