Urology Coding Alert

Question: Can you offer any guidance on how to properly submit advanced beneficiary notices (ABNs)? Georgia Subscriber

Answer: ABNs are often incorrectly completed and deemed invalid by Medicare, which is why it’s critical you fill them out accurately and ensure your patients understand what they’re signing.

Consider these best practices on how to utilize the forms in your organization.

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, the Centers for Medicare & Medicaid Services (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 resident 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:

• Make them easy-to-read: Be sure the language contained in the ABN is easily understood by the beneficiary, with terminology the patient recognizes.
• Address the financial details: You should estimate the cost of the services that will be rendered, so the beneficiary can make an “informed decision,” CMS says.
• Don’t forget about options and signatures: The beneficiary must select an option and sign the ABN.
• List refusal on the notice: When the beneficiary refuses to choose an option, the form must be annotated with this information.