An Advance Beneficiary Notice (ABN) is a waiver of responsibility that is issued to a patient to make sure you receive payment for services and items that are usually covered by Medicare but are not expected to be covered on this occasion. When completed properly, you should be able to recover the cost of the service or item from the beneficiary yourself. ABN notifies the patient in advance of receiving the service of the likelihood of non-coverage. It also gives the patient the opportunity to accept or refuse the item or service and protects the patient from unexpected financial liability if Medicare denies payment. The following five key points will help your medical practice take the necessary steps to increase reimbursement success rates so that you are not left out of pocket.
Educate Patient Why an ABN is Required
You must provide your patient with an ABN before the service or item is provided. It cannot be given to a patient who needs emergency treatment or is under duress. Explain to your patient that by completing and signing an ABN, they are acknowledging that certain procedures or items have been provided and that they accept financial responsibility for them.
Get Familiar with CMS Resources
The ABN is a waiver of liability and it is called CMS-R-131. The complete manual is available from Centers for Medicare and Medicaid Services. You can view it using this link: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf
You can check the specific criteria and download the form on the Centers for Medicare and Medicaid Services website (CMS.gov) you can use this link: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html?redirect=/BNI/02_ABN.asp
Estimate the Costs for a Series of Services
You must make a good faith effort to insert a reasonable estimate for all of the items or services listed under Blank (D). CMS expects that the estimate should be within $100 or 25% of the actual costs, whichever is greater; however, an estimate that exceeds the actual cost substantially would generally still be acceptable, since the beneficiary would not be harmed if the actual costs were less than predicted. Providers may also pre-print a menu of items or services in the column under Blank (D) and include a cost estimate alongside each item or service. If a situation involves the possibility of additional tests or procedures (such as in laboratory reflex testing), and the costs associated with such tests cannot be reasonably estimated at the time of ABN delivery, then you may enter the initial cost estimate and indicate the possibility of further testing.
Patient Signs ABN while Understanding it’s terms
Explain the process step by step. Let them know that if they choose, they can complete section G and ask Medicare to be billed for an official decision on payment. However, if Medicare does not pay, they agree to be responsible for the payment (subject to appeal). Modifiers are used when submitting charges to Medicare; help your staff understand what is involved.
Your Team Understands the Procedure
There may be a need for training or a team meeting at your practice so that everyone understands the process. Often, Medicare will not provide coverage because there is not documented medical necessity, or because the financial limit for the amount of services permitted for a diagnosis has been reached.
Having procedures in place and adequate record-keeping is essential. If your practice is experiencing problems with in-house billing or following up claims, bills are not being issued correctly or on time, or you are experiencing issues with cash flow, consider using an outside company that takes care of your medical billing for you. Outsourcing to a company like Medical Billers and Coders (MBC) will ensure that you won’t lose your revenue. We have dedicated specialists who are well versed with Medicare coverage for various services and so that you don’t have to worry about ABN and can spend more time focusing on patient care. If you’re interested in outsourcing your medical billing and coding to improve revenue for your practice, call us today at 888-357-3226 or write to us at info@ medicalbillersandcoders.com to learn how we can help you.