ABN Issue

[pvtbiller]

Good afternoon everyone,

Can anyone shed some light on an office debate here?  we were advise by pur legal councel to start issuing ABN's to our patient because after going to PDAC and originally they assigend us a misc code (we are a new product), they turned around and gave us a non-covered code (A9270).  This was on our old product and we have a new version now.  If we give out patients abns - would this be considered a "blanket abn"?  if we do this and append the correct modifier are we waiving our rights to appeal and we would have to collect all money upfront from the patient?  I as always appreciate your expertise!

[Michele]

I would check with your legal counsel but I don't believe having the ABN modifier on the claim waives your appeal rights.  I also don't believe you would collect up front.  The ABN just notifies the patient that it may not be covered.  You are still submitting the claim for determination.  That does not require that you collect up front.

[LASHUNDA]

What your legal counsel is telling you is that by now you know if the plan i.e., Medicare will cover the code.  They are suggesting that you have the patient sign an ABN.  To finish Michele's response above she is correct that the ABN alerts the patient that the service may not be covered however the ABN also alerts the patient that if the health plan i.e., Medicare doesn't cover the code then you are allowed to bill the patient based on the ABN which should state that exactly.