I believe the ABN must be signed prior to service provision, and appropriate modifier assigned to the code descriptor.
The purpose of the ABNs is to afford patients the opportunity to make informed healthcare consumer decision, understanding they will be required to cover the cost.
Formerly, in a practice that I worked in, if either the service was non-covered or the diagnosis did not substantiate the service (according to LCD, NCD or LMRP guidelines), an ABN was provided to the patient. This worked qutie effectively from a number of standpoints, including compliance.
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