Question: I’m new to coding. Can you please explain to me what an advance beneficiary notice (ABN) form is and some best steps we can follow to have clear ABNs in our office? Texas Subscriber Answer: Never use “blanket” ABNs to cover yourself just in case a payer denies a service. Instead, you must be sure there is a reasonable basis for noncoverage associated with the issuance of each ABN, CMS says in its publication, “Advance Beneficiary Notice of Noncoverage.” Providers aren’t required to have a signed ABN on hand for services that are never covered by Medicare. However, for those services that are normally a covered benefit — but may not be covered due to medical necessity, frequency, etc. — a signed ABN is required to obtain reimbursement from the beneficiary. You must issue the ABN when: You believe Medicare may not pay for an item or service; Medicare usually covers the item or service; or Medicare may not consider the item or service medically reasonable and necessary for this patient in this particular instance.
Although not required, some experts recommend getting an ABN even when you know Medicare statutorily doesn’t cover a particular service because it engenders good will. That way, you notify the patient upfront that they will be responsible for a charge and how much they’ll be expected to pay, ensuring that everyone is on the same page financially. Take a look at these ABN tips: