Home Health & Hospice Week

After-the-fact ABNs don't do you any good.

Although the ABN form has changed, many of the previous ABN "best practices" remain the same. The following is a quick look at three important ABN facts that could save your billing.

1. Understand the function of the ABN: If you discover that a patient's equipment or services may not be payable by Medicare, but the patient still wants them, the ABN will let the patient know that he or she may be responsible for paying the non-covered portion, and you're required to issue an ABN in this case.

If, however, the item or service you're providing is statutorily non-covered by CMS, you can choose to voluntarily provide the patient with the revised ABN, notifying her that this service is not covered by Medicare and that she is responsible for payment--in other words, exactly how you would have handled the situation using an NEMB form.

Remember: ABNs help patients decide whether they want to proceed with an item or service even though they might have to pay for it. A signed ABN ensures that you will receive payment directly from the patient if Medicare refuses to pay. Without a valid ABN, you cannot hold a Medicare patient responsible for the denied charges, says Kara Hawes with Advanced Professional Billing in Tulsa, OK.

2. Keep fresh copies of the ABN close by. "The patient has to sign the ABN form at the time of service, otherwise the form is not valid," Hawes says. "When the claim is denied without an ABN, Medicare will not allow you to be reimbursed for the service or collect money from the patient."

3. Explain the ABN to the patient. ABNs help the patient understand his options. Once you have completed the ABN and discussed it with the patient, he can: 1) sign the ABN and assume financial responsibility for the items or services in question; 2) cancel the equipment or services; or 3) reschedule the item or services for future dates when he can afford it, or when Medicare may cover them.