Wiki Abn

[NESmith]

Good Morning. If a Medicare LCD states that a test is never covered for screening, do you still have to have the patient sign an ABN or is it OK to charge the patient knowing that the test will not be covered for screening and the patient still wants to have it? I am concerned about not having an ABN. Thanks for your help

 

[mrsclark75]

An ABN should be presented to a Medicare Beneficiary anytime a service is provided for an indication (diagnosis) that Medicare is not likely to provide coverage. The only exception are those services that are statutorily not covered (i.e. Preventative Med Exam 99381-99397, dental exams, etc.). If you are providing a procedure and the diagnosis for which the procedure is being provided is NOT listed under the "ICD-9 codes that are covered" you should have your patient sign an ABN after informing them that Medicare is not likely to pay for this procedure and the patient still wishes to go forward. If you do not have the patient sign an ABN and Medicare denies the service as non covered or not medically necessary (CO 50 rejection code) than you, as the provider, will have to write that charge off and will not be able to bill the patient.