Wiki Medicare and a Family Planning provider

[susansisson]

I have a question about ABNs for Medicare. If a provider is not contracted or credentialed with Medicare because they provide family planning services which are not covered under Medicare can they see Medicare Pts as cash paying clients without a ABN?

 

[thomas7331]

I have a question about ABNs for Medicare. If a provider is not contracted or credentialed with Medicare because they provide family planning services which are not covered under Medicare can they see Medicare Pts as cash paying clients without a ABN?

This is a question you might want to run by a practice attorney instead of ask on a discussion board because it's not an easy answer. It depends partly on what exactly are the 'family planning services' that you say aren't covered. If these are services that are statutorily excluded from Medicare and never covered under any circumstance, this might be OK, but for services that could be covered in some cases but may be denied due to the particular patient diagnosis, you can't use an ABN to simply avoid following the requirements of the Medicare program. If your provider does not wish to enroll or file claims with Medicare but wants to provide certain services to Medicare beneficiaries, the provider may need to file an "opt-out" affidavit to Medicare to notify them that they are doing this, and also make a private contract with the Medicare patient before providing services or accepting payment. The legalities of this are a little complicated so I'd recommend getting a professional opinion because it's important to get this right.