Question ABN USE FOR COMMERCIAL PAYERS

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Lebanon, TN
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WHAT IS THE LEGAL/ETHICAL USE FOR ABN FORMS IN REGARDS TO COMMERCIAL PAYERS? I HAVE BEEN ABLE TO FIND THIS INFORMATION, BUT NOT FOR COMMERCIAL PAYERS. THANKS.
 

csperoni

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Selden
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Your question is a little vague and can be interpreted a few ways.
The legal aspect can vary from state to state, and payor to payor (assuming in network, and have a contract which is a legal document.)
The ethical aspect to me is more of a "customer service" issue. If it is something that I would reasonable expect the provider's office to know ahead of time, it is in EVERYONE'S best interest to have some type of ABN. The patient does not want to feel as though they were tricked or taken advantage of, and the provider's office wants to be paid for services rendered. A signed document prior to services providing the cost does just that.
 

SharonCollachi

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Clovis, CA
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I use what is essentially an ABN when I know the patient's insurance won't cover something or likely won't cover something. I also encourage the patient to call their insurance company themselves if they are unclear about their coverage and benefits.
 
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I'm in the same boat. We are currently working on implementing ABNs in our ambulatory surgery center. I have all the information on Medicare ABNs. For commercial payers do they each have their own ABN or do you use a generalized ABN? Also, do know if you can utilize one for Medicaid patients?
 

csperoni

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I'm not sure about Medicaid. I don't see why you couldn't if a patient wanted a service not covered by Medicaid (for example cosmetic surgery). Regarding commercial payors, I don't recall any requiring their own specific ABN, but you would have to check with the carriers directly. Every carrier seems to like to put odd things in their contracts to make it as confusing as possible. I can recall once (I think it was BCBS) requiring a patient to sign their exact form acknowledging a referral wasn't received and patient would be paying for visit.
We don't use them often, but use the MCR ABN, and then a generic one (that is basically the MCR ABN on our letterhead) for all commercial.
 
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This is very helpful. For now, I have created a general one for commercial payers, including medicare advantage plans, and one specific for medicare. I still welcome further input though. Yes, insurance does make it as confusing as possible.
 
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