As healthcare providers, it is crucial to make sure your patients understand their rights and responsibilities when it comes to their care. It is also important to make sure you’re getting reimbursed for the services you render. This is where the Advance Beneficiary Notice of Non-coverage (ABN) can help.
An ABN is a written notice that doctors provide to Medicare beneficiaries before providing a service or treatment where Medicare is likely to deny payment. Its purpose is to inform the patient that Medicare is unlikely to cover a particular service or item, or that the provider believes the service or item is not medically necessary and by signing an ABN, the patient acknowledges their understanding and agrees to be financially responsible for the cost of the service or item.
The following providers are required to issue ABNs to Medicare patients:
- Physicians, providers (including institutional providers like outpatient hospitals), practitioners and suppliers paid under Part B (including independent laboratories)
- Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A
- Home health agencies providing care under Part A or Part B
Doctors typically issue ABNs in the following situations:
- Non-covered services: If a doctor believes that a particular service or treatment is not covered by Medicare, they may provide an ABN to the patient before providing the service
- Exceeding frequency or quantity limits: Medicare may have limitations on the frequency or quantity of certain services or treatments. If a doctor believes that providing additional services or treatments would exceed these limits, they may provide an ABN to the patient.
- Not medically necessary: If a doctor believes that a service or treatment is not medically necessary, they may provide an ABN to the patient
It's important to note that doctors are required to provide ABNs in certain situations, and failure to do so may result in the doctor being responsible for the cost of the service or treatment. Additionally, patients have the right to refuse a service or treatment if they receive an ABN and do not wish to be responsible for payment. Lastly, you can issue a courtesy ABN for items or services that are not a benefit or never covered by Medicare, but it is not required. If one is issued, the patient does not have to sign the notice and it can be kept in the patient’s file.
When you present the ABN to the patient, it must be done with enough time for them to consider their options and make an informed decision about their care. For example, you cannot issue an ABN in emergency or urgent care situations. The form must be filled in completely and must be reviewed with the patient before they sign it. Once it is signed, one copy is given to the patient and one copy is retained in the patient’s file. If the patient refuses to sign the ABN, the provider should make a note on the original copy of the ABN indicating the refusal to sign and save it to the patient’s file.
With the rising costs of healthcare, collecting reimbursement for the services you render is important and understanding the strict guidelines on ABNs can help you retain that reimbursement.
To learn more about how RCxRules/Alpha II can simplify the ABN generation process, set up a 15-minute meeting today.