Author Topic: Medicare ABN's  (Read 1648 times)

PMRNC

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Medicare ABN's
« on: February 15, 2011, 08:24:16 AM »
I've been working with an family practice to update their Policies/procedures, office policies and financial agreements as well as designing their new patient information sheets with updates for their EMR. I'm going to research this but thought if anyone knew this for sure it would save me time. They want their PI sheets and financial policy to read that "ALL Medicare Beneficiaries MUST complete an ABN (Advanced Beneficiary Notice) for ANY non covered or out of pocket expenses."  Now it's nagging me that I just plain don't think they can do that.. LOL  But wanted to see if anyone else has seen this and what are your thoughts?  I questioned them and they said they wanted that to COVER any out/pocket or non covered for any reason, so their motives are clear.
Linda Walker
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Michele

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Re: Medicare ABN's
« Reply #1 on: February 15, 2011, 12:50:28 PM »
Linda,

    From what I understand, but with no legal background, it is not OK to use a Blanket ABN.  The ABN has to specify the exact service or supply that may not be covered.

Michele
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pattil88

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Re: Medicare ABN's
« Reply #2 on: February 16, 2011, 01:20:59 PM »
I agree Michele - Medicare will not accept a blanket waiver form. The American College of Radiology notified thier constituency (based on CMS guidelines) that "you must notify the patient in writing that Medicare likely will deny payment. The ABN must indicate the specific reason for probable denial. To be acceptable, an ABN cannot state simply 'medically unnecessary' or its equivalent as the expected reason for denial."

You may develop a standardized waiver form, but it is required to be specific to the patient AND the specific procedure. Also, be sure to differentiate "not reasonable and medically necessary" denials (which are usually the result of a diagnosis code not listed under an LCD as an appropriate reason for a procedure) from "noncovered" denials (ie, services always excluded by law or under a nonbenefit category).  Modifiers GA, GY and GZ are also used to indicate the patient's acknowledgement or refusal to sign an ABN.

Hope this helps - you can go to their website at www.acr.org for additional info about ABN's.

PMRNC

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Re: Medicare ABN's
« Reply #3 on: February 16, 2011, 02:20:11 PM »
THANK YOU :)  When I brought up the fact that the ABN in blanket form would not be acceptable to Medicare, their response sort of put clarity on what they were doing  :o ??? they said "Oh it's not going to Medicare, just the patient"   ::) ???  This client so far is really horribly uneducated and so far they have NOT been cooperative at taking my advice so If they don't bend a little long enough to let me do what they hired me to do, I will have to cut them loose. 

Thanks again.. I have a meeting with them tomorrow so the responses were very timely!!! :)
Linda Walker
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Michele

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Re: Medicare ABN's
« Reply #4 on: February 16, 2011, 05:44:56 PM »
Uhmmmm it will be going to Medicare if Medicare requests a copy!   ???  It never amazes me how some providers don't quite connect everything.  I hope I don't seem like I'm putting them down.  I had one once very similar to this.  VERY NICE MAN, but I just couldn't explain things to him.  He made all patients sign an ABN, whether they had Medicare or not, whether they got uncovered services or not, even if they came in to use his bathroom!  He asked me the same question over and over no matter how many times I explained things to him.  "How many Medicare claims can you send in together?"  My answer "There is no number, you submit however many claims you need to submit."  (He had back billing.)  After the hundred millionth time - my answer "23, not 24, not 25, only 23 claims are allowed at a time."

Not kidding.

Michele
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PMRNC

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Re: Medicare ABN's
« Reply #5 on: February 16, 2011, 07:03:56 PM »
Quote
Uhmmmm it will be going to Medicare if Medicare requests a copy!   Huh  It never amazes me how some providers don't quite connect everything.  I hope I don't seem like I'm putting them down.  I had one once very similar to this.  VERY NICE MAN, but I just couldn't explain things to him.  He made all patients sign an ABN, whether they had Medicare or not, whether they got uncovered services or not, even if they came in to use his bathroom!  He asked me the same question over and over no matter how many times I explained things to him.  "How many Medicare claims can you send in together?"  My answer "There is no number, you submit however many claims you need to submit."  (He had back billing.)  After the hundred millionth time - my answer "23, not 24, not 25, only 23 claims are allowed at a time."

ha ha.. there's not enough room in this forum to even tell you how many of these I've had.. LOL It just does NOT surprise me anymore. A few years ago I decided that from here on out ..they get ONE explanation.. and I will even throw in a source..but if they ask me to "PROVE" it anymore after that, I tell them.. Listen you hired me, let me do my job and if you don't agree, we can call the whole thing off.  I hate provider's that tell you to PROVE it.  I had one that could NOT comprehend he could not discount copay's ..the way he was doing it before I took over was just not even entering them, telling the patient's he won't make them pay as long as they kept their next scheduled appt!  ??? ??? After explaining this to him a few times I literally left his office, went home and wrote him a termination letter, sent it certified, and just washed my hands of him. When he got the letter to which it just said "Please refer to Paragraph 4 in subpart a of our contract...  '' he called me and said "Well I didn't know it was ILLEGAL, I just thought you didn't want me to waive them"   I did.. HANG UP THE PHONE!  <BANGS HEAD AGAINST WALL>
Linda Walker
Practice Managers Resource & Networking Community
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