Otolaryngology Coding Alert

Question: A patient called our office to schedule an appointment, knowing that we don’t participate with his insurance plan. He wants to pay cash on the day of his visit. We don’t need him to sign an ABN since he’ll be responsible for payment and we won’t be submitting a claim to the insurer, right? 

Arkansas Subscriber

Answer: An ABN (advance beneficiary notice) is only for Medicare services that may not be considered “medically necessary” and covered by Medicare.  

It is actually proper for a non-participating patient to pay you in full up front in cash (charge card or check) and you submit the claim for their insurance to reimburse them, not you because you are non-par. You don’t need any special forms for this. 

If the patient does not want you to submit a claim to insurance, have him sign a form stating that he is requesting that no claim be submitted by the practice and that he, the patient, will take care of all claims with his insurance since it is non-par.