Get Signed ABN When Possible To Cover Potential Non-Payment

Posted on 28 Dec, 2015 |comments_icon 4|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.

More from this author

View More

4 thoughts on “Get Signed ABN When Possible To Cover Potential Non-Payment

  1. I precisely wanted to thank you very much all over again. I do not know the things I would have undertaken in the absence of the entire pointers contributed by you on that theme. This has been a real alarming case in my view, but coming across the professional fashion you processed it made me to leap over fulfillment. I am grateful for this advice as well as believe you find out what a great job your are putting in teaching the rest through your website. I am sure you haven’t got to know any of us.

  2. My wife and i felt quite fulfilled that Michael could carry out his reports while using the ideas he had when using the blog. It’s not at all simplistic to just happen to be releasing methods which often some others could have been making money from. And we all understand we’ve got the blog owner to appreciate for this. The illustrations you have made, the straightforward site navigation, the friendships you aid to instill – it’s mostly excellent, and it is helping our son and us know that that topic is pleasurable, and that’s quite indispensable. Many thanks for all!

  3. I enjoy you because of your whole hard work on this blog. Betty enjoys going through research and it’s really obvious why. My spouse and i know all relating to the lively method you make important tricks via the website and increase participation from other people about this article and my simple princess is in fact becoming educated a great deal. Take advantage of the rest of the year. You’re carrying out a useful job.

Leave a Reply

Newsletter Signup