​We know to use an ABN when a Medicare fee for service patient is receiving a non-covered service. What do we do when a Medicare Advantage patient receives a non-covered item?

Medicare Advantage and ABNs. Ossur.com

​We know to use an ABN when a Medicare fee for service patient is receiving a non-covered service. What do we do when a Medicare Advantage patient receives a non-covered item?

We know to use an ABN when a Medicare fee for service patient is receiving a non-covered service. What do we do when a Medicare Advantage patient receives a non-covered item?

CMS has made it clear that ABN forms are not to be used with MA patients. This is because the MA plan must offer a pre-determination/pre-authorization service for all items. If the plan denies a service, they must issue an Integrated Denial Notice (IDN)to the patient and referring physician. The IDN outlines the reason for denial and appeal rights, if appropriate.

First, you should not be using ABN forms with Medicare Advantage patients. Instead, you will call for pre-determination with the plan prior to delivering any service. If the service is denied, you may need to ask the patient and/or referring physician for a copy of the denial. You may speak to your patient about initiating an appeal. The patient may also choose to self-pay for the service.

More information about the IDN and MA Denial notices can be found here. 

Medicare Advantage and ABNs

What does this mean for you?