Ob-Gyn Coding Alert
ABNs and Uncovered Medicare Services
Question: Our office obtains advance beneficiary notices each time there is some doubt about whether Medicare will pay for a particular service. Do we also have to get a signed ABN if we know for certain that Medicare will not pay for a service? -- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.
Rhode Island Subscriber
Answer: Not if you're sure Medicare won't pay. If you have found some official documentation from Medicare stating that it never reimburses for a service, an ABN is not necessary.
ABNs are designed for potentially noncovered Medicare services; it's only for those questionable reimbursement areas where Medicare may not pay.
Problem: Medicare does not look kindly on offices that file regular ABNs for services it does not cover in the first place. If your office is filing a lot of unnecessary ABNs, you stand a chance of receiving a Routine Notice Prohibition letter from Medicare.
Solution: Make sure Medicare doesn't already have a reimbursement policy on a procedure before you ask a patient to sign an ABN. Obtaining signed ABNs for services Medicare does not pay for is a waste of time and resources.
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