CODING CORNER: ABNs Ensure You Get Payment For Noncovered Procedures

Tip: Learn when to use modifiers GA, GY and GZ

If you don’t obtain advance beneficiary notices from patients who undergo non-covered treatments, your facility could lose thousands of dollars each year. Follow this expert advice on getting a signed ABN so you can collect payment.
Here’s What Makes an ABN So Important
There are two main reasons you would want to obtain an ABN, says Stacie L. Buck, RHIA, LHRM, president and founder of Health Information Management Associates Inc. in North Palm Beach, Fla. “The first is to increase your revenue, and the second is to reduce your risk or the compliance implications associated with ABNs,” she says.
If the physician recommends that a patient have a treatment or procedure that Medicare may not cover, based on the reported indications, you should request that the patient sign an ABN.
The document will help the patient decide whether he wants to proceed with the service even though he may have to pay for it, and, once signed, the ABN also ensures that your facility will receive payment directly from the patient if Medicare won’t reimburse for it.
Don’t Skip the Details
Be sure the ABN clearly identifies the service/procedure the physician plans to provide, the estimated charge for the service, and why Medicare may not provide coverage. This way, the patient knows exactly what he will be responsible for and why he can expect that his Medicare coverage won’t apply to the procedure.
An ABN affects only those services/procedures you’ve specifically listed for a single encounter date. You should therefore list all services your physician thinks Medicare may deny. You should also include your reasoning for why you think Medicare may deny the service, such as details from Medicare’s coverage plan or examples of similar claims that have been denied.
Services you provide on a separate encounter date require a separate ABN. You’re prohibited from using blanket notices.
Tip: You’ll want one copy of each signed ABN for your records and one copy for the patient.
Except under extremely rare circumstances, the physician should give the patient the ABN before performing the service. In some circumstances, you may not know for certain if Medicare will cover the service. If you’re unsure, err on the side of caution and ask the patient to sign an ABN.
You need to give the patient the opportunity to understand his options. He can: 1) be financially responsible for the exam by signing the ABN, 2) cancel the procedure, 3) reschedule the exam for a future date when he can afford it, 4) refuse to sign the ABN and request that [...]

- Published on 2006-05-16