Wiki Advance Beneficiary Notice Question

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wgmarrs

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Parkersburg, WV
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I fully understand the intent of the ABN - to notify a client of services that Medicare may not cover so that they can knowledgeably decide whether or not to receive the services and the potential payment liability associated with the noncovered services. My question is this: If I know that the client is receiving services that Medicare will more than likely cover, must I still issue an ABN? I have entered a group where the practice has been to issue an ABN to every Medicare patient that is seen - and mark "Not Applicable" in the block where the uncovered services might be listed - because 99% are covered. As a result we have (in effect) 99 ABN's out of 100 that say "Not Applicable" and which the patient is still being asked to sign!

This seems like a wasteful and unnecessary practice. Wouldn't the use of an ABN be limited to those situations where we are recommending a service that may not be covered - and the other situation would be excluded? Thanks.
 
Here is the problem with that. everytime the patient is requested to sign an ABN you are required to use the GA modifier to indicate ABN on file unless it was a voluntary ABN and then you use the GX modifier. The ABN must indicate whether it is a voluntary or mandatory ABN and Medicare instructions require that the entire document be read out loud to the patient. Also Medicare Manual indicates that You are not to obtain an ABN for allservices rendered. Only those that are non covered by policy (voluntary ABN ) or non covered by medical necessity (mandatory ABN)
If you obtain the mandatory ABN and do not use the GA modifier the patient will be instructed to not pay provider. If that happens then you cannot bill the patient.
 
Thanks for the clarification. I was aware of the modifier requirement - just needed to whittle it down to the issue of needing an ABN for covered services. I appreciate your help.
 
I'd recommend you go through the services that your practice performs and identify which of those have an associated NCD or LCD published by your local Medicare contractor. For those services, you can print a copy of the LCD to give to your providers, or create a cheat-sheet or chart to summarize it for them and to show what are the covered conditions, and in cases where the provider may want to order or perform a service for a particular condition or symptom that is not covered under the policy, this would be the case to use an ABN. This is the situation when you'll most commonly require an ABN. As mentioned in the above posts, providers should not issue ABNs for all services, or for services that are known to be covered - only when the service may not be covered for the particular patient's condition.
 
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