ABN Facts [Healthcare Compliance Tips]

Create an Advanced Beneficiary Notice of Noncoverage (ABN) policy/procedure and share with your team.

Do you know how to use an Advanced Beneficiary Notice of Noncoverage (ABN)?

CMS requires a non-covered form to be completed as a protection for their beneficiaries.  But, the form also benefits you to ensure you are paid for services that Medicare does not cover.

Here are six ABN facts that you need to know, which includes:

• ABNs can be issued by providers, independent laboratories, home health agencies, hospices, skilled nursing facilities, etc.

• An ABN must have a clear reason the physician anticipates the service not being covered by Medicare. The form is not required for normal services that are excluded.

• If the ABN is not signed by the patient and Medicare decides not to cover the service, the charge is considered a write-off.

• Each procedure must have a separate ABN. A “blanket” ABN is never accepted.

• Modifiers must be applied to alert Medicare an ABN was signed. Keep a copy for your records and provide the patient a copy.

• If an estimate of services is provided, it must be within $100 or 25% of the actual costs.

Understanding non-covered services and ABNs will play a role in building an effective compliance program.  You don’t want to risk patient complaints to the OIG.  Use CMS guidelines and the information above when creating ABN policies and procedures for your practice.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.