Primary Care Coding Alert

Question: Our office obtains advance beneficiary notices each time there is some doubt about whether Medicare will pay for a particular service. Do we also have to get a signed ABN if we know for certain that Medicare will not pay for a service?

Rhode Island Subscriber

Answer: Not if you're sure Medicare won't pay. If you have found some official documentation from Medicare stating that it never reimburses for a service, an ABN is not necessary. ABNs are designed for potentially noncovered Medicare services; it's only for those questionable reimbursement areas in which Medicare may not pay.

Tip: Make sure Medicare doesn't already have a reimbursement policy on a procedure before you ask a patient to sign an ABN. Obtaining signed ABNs for services Medicare does not pay for is a waste of time and resources.
 
-- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.