My understanding of ABNs is that if the service is never covered, an ABN is not needed. If, however, the service is usually covered but you have reason to believe it may not be covered, you would want to get an ABN.
In the situations we have been discussing in this thread, I would want an ABN for the visit because a visit is usually a covered service.
I do not believe a provider is required to make an adjustment on a noncovered service. But that does bring up the whole issue of transparent pricing!
On the subject of the global surgical package, I completely agree with and understand that concept, but don't most surgeons charge for their visit to determine the need for the surgery, even if the patient is referred/sent by their PCP for a specific surgery visit? There is no reimbursement difference (on the MPFS) between a high risk screening colonoscopy, a non-high risk screening colnoscopy and a diagnostic colonoscopy. It just seems like the GI physicians are out that visit reimbursement when screening is the only reason for the visit.
I really think the whole issue with the screening colonoscopy is that there is no diagnosis code for that office visit except the screening code. I also heard that a Carrier had stated if physicians grab any complaint and use that as the diagnosis for these visits, they would be in trouble. I haven't been able to confirm this, so if anyone has any info, please share!
Thanks so much!