Chiropractic Coding & Compliance Alert

Question: One of our Medicare patients requires services which will essentially come under non-covered maintenance services. If I make her sign an ABN (which she is willing to do), will it suffice for all the subsequent services and visits, or do I ask her to sign an ABN at every visit?

Illinois Subscriber

Answer: Since you are pretty sure beforehand that the requisite service would not be covered, you have made a wise decision to go ahead with an Advance Beneficiary Notice (ABN). The patient will have three options to choose from:

Option 1: The patient is willing to pay the expenses, but requests the DC also files the claim with Medicare. The patient might have a secondary insurance payer who may ask for Medicare’s denial on the claim to allow reimbursement from the secondary insurance plan.

Option 2: The patient agrees to pay the expenses, and does not want the claim to be sent to Medicare. However, she can change her mind in the future and request claim submission at a later date within a permissible time span.

Option 3: The patient chooses neither to receive the service nor pay for it. The DC does not render any service and does not file a claim.

Now for your question: Ideally, the patient should sign an ABN each time she receives a Medicare-covered service that the provider feels might not be reimbursed due to various reasons. That given, you may issue a single ABN to a patient who is to receive the same service repeatedly over a period of time (such as lumbar spinal manipulation monthly for a year). Such ABNs can be effective for up to a year. Remember to describe the specific service rendered and the frequency of treatment. Issue a new ABN if the duration exceeds one year or if your DC decides to perform a different service not listed in the existing ABN.

Tip: Have an ABN signed for each time there is a new condition or it has been more than 30 days since the last visit. Having that ABN on file may help in an appeal situation.

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