Practice Management Alert

Question: Can you offer any guidance on how to properly submit advanced beneficiary notices (ABNs)?

Montana Subscriber

Answer: ABNs are often incorrectly completed and deemed invalid by Medicare Part B, which is why it’s critical you fill them out accurately and ensure your patients understand what they’re signing. Consider these best practices on how to utilize the forms in your organization.

Never use “blanket” ABNs to cover yourself just in case a payer denies a service. Instead, you must be sure there is a reasonable basis for noncoverage associated with the issuance of each ABN, the Centers for Medicare & Medicaid Services (CMS) says in its publication, “Advance Beneficiary Notice of Noncoverage.”

Providers aren’t required to have a signed ABN on hand for services that are never covered by Medicare. However, for those services that are normally a covered benefit — but may not be covered due to medical necessity, frequency, etc. — a signed ABN is required to obtain reimbursement from the beneficiary.

For instance, a practice may require an ABN for removal of impacted cerumen in case the patient had the cerumen removed by another provider and exceeds the frequency limits. Another example may include audiology services. A patient may go from one audiology practice to another in search of second, and even third, opinions. As a result, the encounter may exceed the frequency limits that Medicare Part B puts on these services.

You must issue the ABN when: You believe Medicare may not pay for an item or service; Medicare usually covers the item or service; or Medicare may not consider the item or service medically reasonable and necessary for this resident in this particular instance.

Although not required, some experts recommend getting an ABN even when you know Medicare statutorily doesn’t cover a particular service because it engenders goodwill. That way, you notify the patient up front that they will be responsible for a charge and how much they’ll be expected to pay, ensuring that everyone is on the same page financially.

Take a look at these ABN tips:

• Make them easy to read: Be sure the language contained in the ABN is easily understood by the beneficiary with terminology the patient recognizes.
• Address the financial details: You should estimate the cost of the services that will be rendered, so the beneficiary can make an “informed decision,” CMS says.
• Don’t forget about options and signatures: The beneficiary must select an option and sign the ABN.
• Make sure the GA modifier is appended to all claims where a signed ABN is on file: Modifier GA (Waiver of liability statement issued as required by payer policy, individual case) tells Medicare Part B that a signed ABN is on file. The resultant Remittance Notice that the patient receives informs them that the physician may bill them for the service. If the GA modifier is not included, the patient’s remittance notice will say that the provider may not bill the patient for the service.
• List refusal on the notice: When the beneficiary refuses to choose an option, the form must be annotated with this information.