Ophthalmology and Optometry Coding Alert

Question: Are patients undergoing a keratoconus workup or contact lens fitting still required to sign an advance beneficiary notice (ABN)? Why is it necessary when Medicare won’t pay for it anyway?

Nebraska Subscriber

Answer: According to CMS, the ABN “is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee-for-service) beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.”

You’re correct in noting that the ABN isn’t required in situations where services are statutorily excluded (never covered) by Medicare, such as refraction or corrective contact lens fittings, or do not meet the definition of a Medicare benefit.

The patient’s signature on an ABN is important because it confirms the fact that you’ve shared the estimated cost that the patient will have to pay for these services, even though they’re not covered, and it therefore curbs the odds that you’ll face patient confusion when they get the bill for these services.

For instance: Some Medicare patients don’t know the refraction is not a benefit. Even though Medicare doesn’t pay for refraction, patients may still be confused if they get a bill for this service, so it’s in your best interest to have patients sign ABNs that clearly explain that the service isn’t covered, as well as what you charge for it.