Think Medicare Might Not Pay? Get an ABN

Posted on 19 Dec, 2015 |comments_icon 1|By Chris Boucher

ABNs can also help build rapport with patients.

If your practice doesn’t obtain signed advance beneficiary notices (ABNs) when necessary, it could be letting deserved reimbursement fly out the window.

Reason: Whenever your practice provides a service that Medicare might not cover, or cover completely, the ABN notifies the patient of that fact. Having a signed ABN will allow you to bill the patient for the service. Without the ABN, you have no billing recourse. 

Example: A Medicare patient requests an EKG, but appears not to meet the medical necessity criteria for the screening. If you have a signed ABN on file, you can bill the patient for whatever portion of the EKG Medicare won’t pay for.

Expert Links ABNs to Patient Satisfaction

According to Leslie Johnson, CPC, CSFAC, chief coding officer at PRN Advisors in Palm Coast, Fla.,

ABNs also help with patient relations. She calls ABNs “a good habit for a practice to work into their routine, even if it seems difficult.”

Reason: Trust. ABNs show “a respect between the practice and the patient by stating what the cost will be, and giving the patient the choice as to whether or not they wish to proceed,” explains Johnson.

The patient might not like what he hears, but it beats getting an unexpected medical bill.

“By giving the patient this kind of respect, it places the provider and the practice in a win-win situation,” Johnson says.

See also: Validate Signature Before Signing Off On Claims

Get ABNs For Any Potentially Uncovered Service

To further solidify relations with patients, Johnson recommends giving them ABNs even when you know that Medicare will deny the service. (Medicare does not require an ABN if it explicitly excludes the service by statute.)

This will further enhance your credibility with patients, Johnson explains.

“Financial care of the patient goes hand-in-hand with their physical and emotional well-being,” she says. “If they know what to expect, they can be in better compliance with the physician’s directives.”


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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