10 Feb Maneuvering Medicare: What’s an ABN?

An ABN is an “advanced beneficiary notice”, in other words it’s a waiver of liability.  An ABN serves as a warning that Medicare may not pay for care that the provider recommends for a patient.  When do you have to give a patient an ABN? Providers must give patients an ABN when they believe that items or services they are recommending may not be covered by Medicare.  When does this happen? Sometimes a provider might find that they recommend certain care for a patient but know that Medicare will likely not cover part or all of the service provided for a variety of reasons.  It is then the responsibility of the provider to disclose this information to the patient in the form of an ABN so that the patient may make an informed decision on whether or not they wish to receive the recommended item or service.  

To meet guidelines, the ABN must contain the following three things:

 

  1. The item or service that the physician isn’t expecting Medicare to pay for
  2. An estimate of how much the item and/or services will cost the patient
  3. The reasons why the physician believes Medicare may not pay for the item or service. An example of this might be that Medicare only pays for a certain test once every four years and this   might be the second test in three years

 

Best Practices for ABNs:

 

Follow these best practices to make sure that you are informing your patients properly of the financial costs they are taking on by proceeding with the recommended service:

  • List the actual service you are recommending the patient receive
  • Make sure you sign the ABN at the time of service and not at a later date
  • You must use CMS’s approved ABN form and complete all blank spaces
  • Do not give ABN’s out haphazardly. Make sure they are only being issued in instances where the physician believes that Medicare might not pay for a recommended treatment

ABN’s do not need to be issued in instances where Medicare never covers the item or service.

By adhering to these best practices, you not only inform your patients of their financial responsibilities, but you also avoid being liable for having to write off claims due to failure to issue ABN’s correctly.

For more information on ABNs please visit www.medicare.gov.

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