ABN for DME products

skettyb

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Do you recommend to routinely have an ABN signed for a DME product for Medicare patients even if you are 99% positive the item will be covered by their insurance? Thank you
 

CodingKing

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No that's actually prohibited by CMS to do routine ABN's, blanket ABNs are also prohibited.


https://med.noridianmedicare.com/web/jeb/topics/abn

Health care providers/suppliers are prohibited from issuing ABNs on a routine basis (i.e., where there is no reasonable basis for Medicare to not cover). Providers and suppliers must be sure that there is a reasonable basis for non-coverage associated with issuance of each ABN. Some situations may require a higher volume of ABN issuance. As long as there is proper evidence for ABN use, provider will not have violated routine notice prohibition
 
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CodingKing

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I did not mean "blanket" ABNs. They are person specific, item specific, price specific, date specific.

I was just giving "blanket" as one of the examples of a prohibited ABN situation. Yours would fall under the prohibition against routine ABN or a "CYA" ABN as I call it. It should not be filled out unless you are "99%" sure it will NOT be covered but the patient wants it anyways. Its not to be filled to cover the chance you are wrong about it being covered. Really there is no excuse for not knowing the exact requirements for coverage under Medicare.
 

Cady4217

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The only DME I have ever gotten an ABN signed for is a lift chair. Basically everything else will be somehow covered, as long as it is documented and for use within the home.
 

jbmonroe

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Specificity required for ABN's

ABN's are often misunderstood. You must specify the reasoning behind your belief that an item will not be covered. This assumes you are familiar with the LCD's and NCD's and can state to the patient in clear terms why their case does not meet coverage requirements. Overuse of the ABN modifier will trigger CMS to take a closer look at your claims and could result in a higher number of audits.
 
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