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Thread: ABN Use and Co-Insurance/Co-Pay Collection

  1. #1
    Join Date
    Apr 2007
    Coeur D'Alene, Idaho

    Question ABN Use and Co-Insurance/Co-Pay Collection

    AAPC: Back to School
    I work for a new ASC (we opened our doors in May), and we *finally* got our CMS approval effective 12/7/09. And I have a question regarding co-insurance/co-pay collection for patients that have Medicare replacement plans such as Sterling or Secure Horizons.

    We were told that we could treat Medicare patients so long as we notified them that we were unable to bill their insurance and have them sign an ABN stating that we could not bill Medicare because we were still awaiting CMS approval.

    So for example, a Sterling patient comes in for a colonoscopy. We verify their eligibility with Sterling and what their co-insurance will be for a colonoscopy in an outpatient setting. Let's say it's 10%, so on the day of surgery we collect 10% based on the Medicare allowable for outpatient centers in our area as well as have the patient sign the ABN. Is this allowed?

    Basically, can we collect co-payment (not the portion the plan would normally pay) from patients with Medicare replacement plans for Medicare covered services if we were a non-covered provider?

  2. #2
    Join Date
    Apr 2007
    Bentonville, Arkansas

    Default Medicare Advantage Plans

    If no contracts are in place for the Medicare Advantage Plans, and you are only accepting the PFFS plans, there should be no need for an ABN, and you can collect whatever that company advises you the patient will be responsible for.

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