Pain Management Coding Alert

Published on Wed Mar 30, 2016 PDF

Also, check out how ABNs can lead to healthier patient relations.

When patients report to your practice for a procedure that Medicare might not cover completely— or at all — get the patient to sign an advance beneficiary notice (ABN).

Rationale: ABNs notify your Medicare patients that the payer might not cover the bill. Having a signed ABN prior to the service/procedure will allow you to bill the patient for the service. Without the ABN, you have no billing recourse.

Check out this advice on when to issue an ABN, and best practices for getting patients to sign on the dotted line.

Check for These 3 Common ABN Scenarios

According to Steven M. Verno, CMBSI, CHCSI, CMSCS, CEMCS, CPM-MCS, CHM, SSDD, a coding, billing, and practice management consultant in central Florida, you should strive to get a signed ABN when:

• You believe Medicare may not pay for an item or service;
• Medicare usually covers the item or service, but might not for some reason; or
• Medicare may not consider the item or service medically reasonable and necessary for this patient in this particular instance.

Get ABNs for Any Potentially Uncovered Service

To further solidify relations with patients, Leslie Johnson, CPC, CSFAC, recommends giving them ABNs even when you know that Medicare will deny the service. (Medicare does not require an ABN if it explicitly excludes the service by statute.)

This will further enhance your credibility with patients, explains Johnson, chief coding officer at PRN Advisors in Palm Coast, Fla.

“Financial care of the patient goes hand-in-hand with their physical and emotional well-being,” she says. “If they know what to expect, they can be in better compliance with the physician’s directives.”

Expert Links ABNs to Patient Satisfaction

ABNs also help with patient relations. Johnson calls ABNs “a good habit for a practice to work into their routine, even if it seems difficult.”

Reason: Trust. ABNs show “a respect between the practice and the patient by stating what the cost will be, and giving the patient the choice as to whether or not they wish to proceed,” explains Johnson.

The patient might not like what he hears, but it beats getting an unexpected medical bill.

“By giving the patient this kind of respect, it places the provider and the practice in a win-win situation,” Johnson says.

Do This When You Cannot Issue ABN In-Person

If at all possible, Medicare wants providers to issue an ABN directly to the patient, Verno says. When this is not possible, you may issue an ABN via:

• Direct telephone,
• E-mail,
• Traditional mail, or
• Secure fax machine.

If you can’t document that the patient received the ABN in person, Verno advises that you note it in the patient’s record. Then, the beneficiary must send a signed ABN back to your practice — if at all possible.

Alternative: In case the patient does not sign and return the ABN before the procedure, Verno recommends you “keep a copy of the unsigned ABN on file. If the beneficiary fails to return a signed copy, document the initial contact and subsequent attempts to obtain a signature in appropriate records or on the ABN,” he explains.