Wiki ABN help

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JaycieG

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I have started taking the CPC course and was reading regarding the ABNs. Its under my understanding that you cannot bill the patient any balance if you do not have the patient sign an ABN. I have seen some charges that Medicare has automatically put in patient responsibility even though there wasn't an ABN signed and there wasn't a GA modifier used. ex. Male patients that were not 50 yet and they have a PSA screening done. There was not an ABN signed and Medicare put it in patient responsibility. We have talked to Medicare and they do say that we can bill the patient with no ABN but I kind of disagree with what I read.

Need some clarification for it.

Thank you
 
It's incorrect to say that you cannot bill the patient any balance if you do not have the patient sign an ABN. ABNs are not required in order to bill patients for items or services that are excluded from Medicare coverage. For practical purposes, the most common scenario for which an ABN is needed is for a service that is usually covered but which may be denied as not medically necessary in the particular patient's case.

Here is a publication from CMS that is a good reference and goes into this in more detail:
https://www.cms.gov/Outreach-and-Ed...NProducts/downloads/abn_booklet_icn006266.pdf
 
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