Get Signed ABN When Possible To Cover Potential Non-Payment

Posted on 28 Dec, 2015 |comments_icon 1|By Chris Boucher

Patient won’t sign ABN? Be sure to document it.

In certain situations, it might prove difficult to get a signed advance beneficiary notice (ABNs) from a patient when appropriate. Make every effort to get the ABN for any service that Medicare might not pay for, however, or your office could be financially responsible for any unpaid patient services.

And if you aren’t successful in delivering the ABN, you need to note it in the patient’s record.

For more info on issuing ABNs, we picked the brain of Steven M. Verno, CMBSI, CHCSI, CMSCS, CEMCS, CPM-MCS, CHM, SSDDa coding, billing, and practice management consultant in central Florida.

According to Verno, you should strive to get a signed ABN when:

  • You believe Medicare may not pay for an item or service;
  • Medicare usually covers the item or service, but might not for some reason; or
  • Medicare may not consider the item or service medically reasonable and necessary for this patient in this particular instance.

Example: A Medicare patient insists on a colonoscopy, even though he does not meet the medical necessity criteria for the screening.

ABN alert: Since the patient did not meet medical necessity criteria for the colonoscopy, you should get a signed ABN before performing the procedure.

See also: Put Locum Tenens Physicians On 60-Day Clock

Use Alternative Means When In-Person ABN Issuance Impossible

If at all possible, Medicare wants providers to issue an ABN directly to the patient, Verno says. When this is not possible, you may issue an ABN via:

  • Direct telephone,
  • E-mail,
  • Traditional mail, or
  • Secure fax machine.

If you can’t document that the patient received the ABN in person, Verno advises that you note it in the patient’s record. Then, the beneficiary must send a signed ABN back to your practice — if at all possible.

Alternative: In case the patient does not sign and return the ABN before the procedure, Verno recommends you “keep a copy of the unsigned ABN on file. If the beneficiary fails to return a signed copy, document the initial contact and subsequent attempts to obtain a signature in appropriate records or on the ABN,” he explains.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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