Medicare ABN

[justasking]

Hi,
I bill for a radiology company and we have a burning debate in our office.

We have all MEDICARE patients sign an ABN for screening mammogram exams. The reasoning is that we have to rely on the patient to inform us if they have had a screening mammogram with in the year at another facility. If they have and we do the screening mammogram then the claim will deny for-Frequency routine exam done with a years limit. (since Medicare will only pay for one screening a year). Believe it or not alot of patients can not remember if they have had the exam with in the year at another facility!

The burning question is......Is this considered a "blanket ABN" since we are having every mammo patient sign it.

Thanks in advance!

[Anand]

Yes, it is considered to be the "Blanket ABN" but what i have heard is that in generally, pt should NEVER be asked to sign a "blanket" ABN Form, but i think in your case its little different.

If the ABN Form is not properly completed and the other required paperwork is not submitted it is not PERMITTED TO BILL THE PATIENT FOR THE SERVICE. so pls ensure to check if everthing is filled properly. 

[Pay_My_Claims]

It is NOT a blanket ABN.  You are doing the right thing.

The typical reasons that Medicare will not cover certain services and that would be applicable are:

   1. Statutorily Excluded service/procedure (non-covered service)
   2. Frequency Limitations
   3. Not Medically Necessary

Statutorily Excluded items are services that Medicare will never cover, such as (not a complete list):

    * Complete physicals (excluding Welcome to Medicare Screenings, with caveats)
    * Most immunizations (Hepatitis A, Td)
    * Personal comfort items
    * Cosmetic surgery

For these items, it is a good idea (not a requirement) to complete the ABN and have the patient check the appropriate box under options and sign the ABN. For the sake of the billing department, I strongly encourage the use of ABN’s for statutorily excluded items.

Frequency Limitations are for services that have a specific time frame between services. For example, Medicare allows one pap smear every 24 months if the pap is normal.  If the patient wants one every 12 months for their peace of mind, Medicare will pay for year one and the patient will pay for year two and that pattern continues. The ABN needs to be on file for the year that the patient is responsible for paying.  If the patient fits Medicare’s guidelines for “high risk” they are allowed to have the pap every 12 months and no ABN is required.