Podiatry Coding & Billing Alert

Question: I'm a bit confused about the purpose of Advance Beneficiary Notice (ABN). When should I ask a patient to sign prior to the service?

Colorado Subscriber

Answer: The written notice is your practice's way of informing the patient (a.k.a. the beneficiary) that Medicare might not cover a particular service or procedure. When the patient signs the waiver, it means she acknowledges that she may have to pay for the procedure or service -- if Medicare decides not to.

Why won't Medicare pay? It only allows for a finite number of certain procedures per patient per time period. Moreover, Medicare doesn't cover some procedures (for instance, routine physician checkups including the lab tests associated with the routine physical exam and elective procedures such as cosmetic surgery).

ABN serves two important purposes: 1. to ensure reimbursement for services provided but deemed not covered by Medicare, and

2. to reduce the risk of compliance implications associated with ABNs.

Remember: ABNs help patients decide whether they want to proceed with a service even though they might have to pay for it. A signed ABN ensures that the physician will receive payment directly from the patient if Medicare refuses to pay.