Neurology & Pain Management Coding Alert

Question: Our Medicare patients sign an advance beneficiary notice (ABN) that complies with HCFA guidelines. Our business office tells me that Medicare frowns on our submitting so many claims with these waivers. Why is this wrong?

Washington Subscriber

Answer: Medicare frowns on using an ABN without thought. If you think the service may be denied, use the ABN. If you know that it will be paid, it is not necessary. If you use the ABN, take the time to explain to patients what it is. If they are being asked to sign with no explanation, Medicare may look on that unkindly because the purpose of the ABN is to allow the patient to be an informed consumer and deny the service if they choose. Please note that it must be signed before the service is rendered.

Further, ABNs are supposed to be used when a service is covered by Medicare, but may be denied due to lack of medical necessity (test for an unapproved diagnosis code) or for frequency (test that is covered once every three years and has already been performed on this patient within the allowed time frame). For example, an ABN is not appropriate for a confirmatory consultation (99271-99275) that the carrier did not request and has already said they would not pay provided the patient is a Medicare patient.

It is not necessary to have patients sign an ABN for a noncovered service because there is no chance of reimbursement. Some offices will have one signed anyway to have documentation that patients understood that they were responsible for payment.