Wiki Abn

[AliMontone]

I will be starting as a practice manager for a Psychiatrist, as of right now she does not accept Medicare or a lot of other insurances, most are self pay. Are they required to have patients sign an ABN? I have never worked for any physicians who did not accept Medicare but I was under the impression this (the ABN)is only for patients covered under Medicare.

 

[thomas7331]

You're correct that ABNs are for Medicare patients only. But the ABN is a notice for services provided to Medicare patients which the provider believes may not be covered - it is not for use in the situation that a provider does not 'accept' Medicare. If providing services to Medicare patients, a provider cannot simply elect to not accept Medicare and collect from Medicare patients as self pay - there are strict rules that must be followed. Providers have the option of either 'not accepting assignment', in which case the provider must still enroll, file claims and otherwise adhere to Medicare regulations and payment caps; or of 'opting out' of Medicare. The rules for opting out are complex and I'd recommend researching this further or getting legal guidance if your provider chooses this option. There is a requirement to file an affidavit with CMS and also of entering into a private contract with the Medicare patient who will receive services under this arrangement.

 

[AliMontone]

Thank you for your response. This physician has been in practice for 20 years and has never accepted Medicare and does not currently see Medicare or Medicaid patients. I will know more once I start, but in speaking with her billing staff, they were under the impression they had to have people sign the ABN, (one of them went to a seminar and must not have fully understood) no matter what insurance, may have been confusing the ABN with "waivers" that some commercial insurances have. The physician was recently approached about seeing patients at a local hospital and they want her to be credentialed with Medicare, so I believe I'll have to start the credentialing for part B and probably Palmetto GBA as well if they haven't done so, so that she'll be able to see the patients in follow-up in the office.

 

[Wenehoka]

Couple of sceneros, I'd would really appreciate some opinions on.

I'd appreciate some opinions or thoughts, if they would be considered fraudulent. It concerns a friend of mine, and I feel they are or at least unethical, but my friend was told they weren't by another friends office manager she knows and spoke to about it. She is fairly young and has only been working as a medical receptionist for a few years with this one office.

A supervisor has been over the practice for only a short period of time. (About 2-3 years,) The past few months she has been working the aging reports, and having the office clerks sending out statements. Some/Most of the claims are Medicare and well past timely filing limit. From 1 to 7 or 8 years or even older. Unless a patient calls in and says they have Medicaid 2nd, and state they can't afford to pay. They are billed until they pay. If they do call in, the office clerks are to tell them they will need to come in with their card to show proof (alot of the patients live hours away) and only then will she provide a write off. If they do not do this, she says they are responsible for the balance and collects from them.

None have a ABN on file, in almost all cases the patients were not verbally notified or there is nothing noted in their accounts to show that they were, told the practice is a non-par. And again alot of the claims are aged by two years or more.

Also the office clerks are not to enter the Medicaid card (in inactive status)into the patient account to show reference for check in, check out or billing that the patient has medicaid secondary even just for informational purposes.

The 2nd scenero...
A clerk has a patient call in to pay her bill. This patient has Cigna coverage only, she has been paying religiously on a large surgical bill for the past few months. The office clerk finds when she pulls up the account it was showing a insurance credit balance of over $5,000. And a patient credit balance of $75.00. The clerk remembers this was an account that she herself had found the charges were actually billed out twice a couple of months ago and had already brought it to the supervisors attention, and at that time the supervisor told her to contact Cigna to recoup one of the payments, the clerk did said she sent the recoup request that day. But clearly the patient had been continuing to recieve a statement and pay payments. Even though there is a credit balance in the system.

The clerk placed the patient on hold, and consulted with the supervisor, and was told "tell the patient the balance had been satisfied." Then continues to tell her that she "did not need to tell the patient she had a credit balance, nor that the surgery was billed out twice. Just that she did not owe anything else."

The patient understandably confused, asked for a print out of the fiancial history for her records. So the clerk, sent the patient a copy, and it shows the patient credit balance as well as the insurance credit, so the patient will see she is owed a refund.

But am I wrong thinking the supervisor is committing fraud or at the very least extremely shady? This is only 2 situations of several others, she has confided in me about. I'd just like to hear some thoughts on the best way to advise her.

Thanks for taking the time to read. I know it's lengthy.

 

[marytwalsh]

Yikes

both scenarios are NOT ok

RE: Some/Most of the claims are Medicare and well past timely filing limit- //Practice should write these off as a loss

RE: " Also the office clerks are not to enter the Medicaid card (in inactive status)into the patient account to show reference for check in, check out or billing that the patient has medicaid secondary even just for informational purposes. " .....// Fabrication - completely wrong instruction

FYI Practice cannot bill a Medicaid patient - Office can check their eligibility on line. Medicaid budgets are only year by year so once the time is past there is no money for Medicaid to pay the practice takes a loss

.RE: ....was told "tell the patient the balance had been satisfied." Then continues to tell her that she "did not need to tell the patient she had a credit balance, nor that the surgery was billed out twice. Just that she did not owe anything else. // WHAT?? Honesty is the best policy and it keeps you out of court