Is your medical practice using ABN or advanced beneficiary notice to safeguard against the risk of non-payment by Medicare? While ABN is limited in use, it is undoubtedly a payment safety net for collecting payments for certain medical services. ABNs also ensure that your patients are informed about the cost of medical service and their financial liability before opting for it.
Here are answers to six commonly asked questions on ABN and the impact on medical practice revenues.
1. What is advanced beneficiary notice?
An advance beneficiary notice or ABN is a written declaration that a provider gives to the patient if there is a risk that Medicare may not cover the medical service. The patient must sign the ABN form as acceptance of the risk before receiving the service. In the absence of payment by Medicare, the liability of paying the medical bill falls on the patient.
The possible reasons for a denial of a medical claim by Medicare are:
-The services have exceeded the cap amount.
-The patient is eligible for a limited number of services.
-The medical service or procedure is risky, experimental, ineffective.
-The medical service is not a medical necessity.
-The claim is for skilled home nursing services for a patient who is not homebound.
ABN is used for Original Medicare plans but does not apply to Medicare Advantage plans, Medicare Managed Care Plan, or Private Fee-for-Service Plan. ABNs are not obtained for medical services excluded from Medicare coverage.
2. Can an ABN be issued as a standard procedure at a medical practice?
Issuing ABN cannot be a blanket policy at a medical practice. ABN’s must only be taken before providing a covered service where there is an element of doubt. Also, ABN’s should not be issued to a patient who is under duress or requires emergency treatment.
Please note that an ABN does not obviate the need to ensure that a patient is made aware of the financial policy of your medical practice.
3. How does an ABN benefit the patient?
An advance beneficiary notice helps patients assess the financial risk of a medical procedure. Depending on the potential cost of the procedure and ability to pay, a patient may choose not to opt for that service. An ABN contains an explanation by the provider on why Medicare may decline the claim. Therefore, an ABN protects the interests of the patient as well.
4. What happens if the patient does not want to sign an ABN?
If a medical practice recommends that the patient sign an ABN, but the patient refuses to do so, then the medical practice can refuse that service, test, procedure, or service to the patient. Also, if a patient does not sign the ABN, they lose the right to appeal a denial with Medicare.
5. What are the conditions under which a patient is not liable to pay even though they have signed an ABN?
A patient is within their right to refuse payment for a medical bill even if they have signed an ABN under the following cases:
-ABN is signed after the medical procedure or service was performed.
-The ABN is not legible.
-The ABN is difficult to understand.
-It is signed during an emergency service.
-The ABN does not provide all the details, including the date and cost of service and reasons for potential decline by Medicare.
6. How does ABN impact practice revenues?
A signed ABN ensures that your practice gets paid for services rendered. However, the accuracy and time of issuance of the ABN are crucial. Ensure that your providers and billing staff are trained in identifying services that typically require an ABN. They must also know how to fill the ABN form using ABN-specific Medicare modifiers. Alternatively, ensure that the practice EMR is preloaded with the limitations of Medicare coverage. Use the EMR to populate an alert for obtaining an ABN for non-covered services.
Is your medical practice effectively using ABN as a patient collection mechanism? Do you have queries on medical claims that involve an advance beneficiary notice? We’d be happy to answer your questions. Contact us now.
