Wiki Question Regarding ABN Form

[AliMontone]

I have always worked for physicians who accepted Medicare and Medicare Advantage Plans/Supplements, etc. I will be starting next week with a new physician who does not participate with and is not credentialed with Medicare or any supplement/advantage plans. Basically a self-pay office (Psychiatrist) with a few major health plans accepted. My question is, are they to be using the ABN for any patient? It is my understanding, and I may be incorrect, that this form is to be signed by patients, prior to a service being performed, who have a Medicare plan for services that are either known to not be covered or may not be covered. Thank you for any help!

 

[Girlzsmom66]

I also need this information

Following....

I also work for a self pay office and am told by another provider (from another state), that we should be having patients sign an ABN. So far, I haven't seen anything to prove this.

Thank you!

 

[AliMontone]

Abn

I know some insurance companies have "waivers" for patients to sign, but I am unsure as to an actual ABN Medicare form for all patients, it just doesn't make sense to me. Any help or direction would be greatly appreciated!

 

[pattiland]

Abn

Having a patient sign an ABN protects your ability to bill the patient when you expect Medicare will not pay for the service.

from the CMS ABN Guidelines:

https://www.cms.gov/Outreach-and-Education/.../abn_booklet_icn006266.pdf

You must issue an ABN when you expect Medicare
may deny payment for an item or service because:

™™ It is not considered reasonable and necessary
under Medicare Program standards;
™™ The care is considered custodial;
™™ Outpatient therapy services are in excess of
therapy cap amounts and do not qualify for
a therapy cap exception;
™™ A beneficiary is not terminally ill (for
hospice providers only); or
™™ A beneficiary is not homebound or there is no need for
intermittent skilled nursing care (for home health
services only).

If you don't issue an ABN:

When an ABN is required and you do not issue an ABN or
Medicare finds that the ABN is invalid and you knew, or should
have known, that Medicare would not pay for a usually covered
item or service, you may be financially liable if Medicare does
not pay. You cannot collect funds from the beneficiary. If you
previously collected payment from the beneficiary, you must
refund the beneficiary the proper amount in a timely manner.

And make sure you use the correct modifier on any service provided to a beneficiary. The modifiers related to ABNs are GA, GX. GY and GZ. They are explained in the pdf link above.

I think these rules cover participating providers and non-participating ones. Somewhere on the CMS ABN website you can download a editable ABN that you can customize to your office and services provided.

There is a lot of info about ABNs on the web. Most of it easier to understand than the CMS sources. Maybe there's a professional state organization that has info for you.

Good luck!