smilingswan
New
Hello, I need clarification on the ABN requirement for a CPM machine where the patient has not had a total knee replacement.
The CGS Medicare Jurisdiction C Supplier Manual states "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e. care that is never covered) or most care that fails to meet a technical benefit requirement (i.e. lacks required certification)." This leads me to believe that an ABN is not required in this situation, since CPMs are never covered if there has not been a TKR/TKA.
Is my thinking correct? Previously we have been obtaining the ABN and billing Medicare for the denial, which drags out the billing process. My manager is of the belief that it is required, and the language in the Supplier manual is not particularly clear.
Thanks for any help!
The CGS Medicare Jurisdiction C Supplier Manual states "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e. care that is never covered) or most care that fails to meet a technical benefit requirement (i.e. lacks required certification)." This leads me to believe that an ABN is not required in this situation, since CPMs are never covered if there has not been a TKR/TKA.
Is my thinking correct? Previously we have been obtaining the ABN and billing Medicare for the denial, which drags out the billing process. My manager is of the belief that it is required, and the language in the Supplier manual is not particularly clear.
Thanks for any help!