Chiropractic Coding & Compliance Alert

Question: We have a patient who was put under maintenance therapy. She was given an ABN and signed it. However, now when the time to pay the bill has come, the patient says she did not understand the ABN form completely and is therefore unwilling to pay. What should be done in this case?

Utah Subscriber

Answer: The patient must pay. An ABN is a written notice a provider gives a Medicare beneficiary before furnishing items or services when the provider thinks that Medicare will not pay on the basis of medical reasonableness or medical necessity. Remember these additional factors:

• Making informed decisions: You’ve already put the patient on notice that Medicare coverage is unlikely. With this information, the patient is then in a better position as a healthcare consumer to make an informed decision about which services she may have to pay for out of pocket or through other insurance.
• Mistake: When issuing an ABN, you must advise the Medicare beneficiary that she will be personally and fully responsible for payment of all items and services specified on the ABN if Medicare denies the claim. According to Medicare’s website, you should give this information to the patient before you take her back to the room.

Suggest that the patient contact Medicare if she has further questions.

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