ED Coding and Reimbursement Alert

Question: Should we use advance beneficiary notices (ABNs) in the ED?

Iowa Subscriber
 
Answer: The rules for obtaining an ABN do not pertain to services furnished in an emergency room before a patient is stabilized. Medicare will pay only for services that it determines are reasonable and necessary under section 1862(a)(1) of the Medicare Carriers Manual.
 
ED physicians view the conflict between the Emergency Medical Treatment and Active Labor Act (EMTALA) and the ABN as a major problem. Medicare requires private practices to give beneficiaries the ABN before providing treatment if it is not covered by Medicare, but whenever a beneficiary presents to the ED believing it is a medical emergency, Medicare must pay for that patients care.
 
EMTALA, however, forbids ED doctors and staff from inquiring about a patients insurance status in an emergency before the persons condition is stabilized.
 
To avoid violating EMTALAs patient anti-dumping statute, ED personnel should not request a financial-responsibility form or an ABN prior to providing the patient a screening exam. Also, the patients completion of registration and financial-responsibility forms should not be a condition for the screening and treatment. An ED may ask during registration whether the patient is insured and the identity of the payer, as long as the inquiry does not delay the patients screening or treatment.
 
Another significant issue involves signing ABNs. Although Medicare recommends that ED staff not request a beneficiary to sign an ABN prior to the provision of screening and treatment, it might be permissible in some cases. For example, it might be appropriate for a patient to complete an ABN prior to treatment when presenting to the ED with truly nonemergent conditions, as long as treatment does not depend on completion of the ABN.