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Linda Collins Blogger

All About ABNs

Posted by Linda Collins | November 08, 2016

​Advance Beneficiary Notice of Noncoverage (ABN) is a form used to notify patients when Medicare may deny payment for an item or service.  Medicare has requirements on when and how to use an ABN.

Medicare created ABNs as a patient protection tool. The ABN allows your Medicare patients to decide whether to receive certain items from you when they might have to pay for them because Medicare doesn't. 

From your perspective as a supplier, the ABN proves that your patient knew that Medicare might not pay for the service before you delivered the item to her. This is important because failure to issue a valid ABN to Medicare beneficiaries prevents you from billing them for those items. 

When completing the ABN, you will enter a brief description of the product, the reason Medicare is likely to deny the item, and the estimated cost of the item to the patient. The patient signs the ABN and is given a choice of having you bill Medicare for the official denial or releasing you from billing the claim. Either way, you can collect payment from the patient at the time you deliver the device.

What does this mean for you?

You need to be familiar with the medical necessary items and requirements for the devices you distribute to patients. This information is detailed in the appropriate Local Coverage Determinations (LCDs.)

Know the reasonable useful lifetime of an item. Medicare defines a Reasonable Useful Lifetime (RUL) for many items. RUL is the expected minimum lifespan for the item. If a same or similar item is given within the RUL it will be denied. Be sure to check for "same and similar" items the beneficiary may have received.

Be familiar with items never covered by Medicare. Medicare's brochure "Items and Services That Are Not Covered Under the Medicare Program" provides a comprehensive overview of the topic.

Use the correct modifier to report use of an ABN.

GA Waiver of Liability Statement Issued as Required by Payer Policy, Individual Case - Use this modifier to report when you issue a mandatory ABN for a service as required and it is on file. You do not need to submit a copy of the ABN, but you must have it available on request.

GX Notice of Liability Issued, Voluntary under Payer Policy - Use this modifier to report when you issue a voluntary ABN for a service Medicare never covers because it is statutorily excluded or is not a Medicare benefit. You may use this modifier in combination with modifier GY.

GY Item or Service Statutorily Excluded, Does Not Meet the Definition of Any Medicare Benefit - Use this modifier to report that Medicare statutorily excludes the item or service or the item or service does not meet the definition of any Medicare benefit. You may use this modifier in combination with modifier GX.

Remember to use the ABN when appropriate, but avoid using ABNs in all situations. Medicare frowns upon the use of blanket ABNs.

You may bill and collect funds for non-covered items or services immediately after the beneficiary signs the ABN.

More information may be found in the Medicare brochure "Advanced Beneficiary Notice of Noncoverage."

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