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Linda Collins Blogger

Same or Similar, Part Two

Posted by Linda Collins | June 04, 2015

You have a prescription to provide a brace to a Medicare beneficiary. You check the appropriate DME MAC website to determine if the beneficiary has received a same or similar device in the past. The online record indicates the patient received an identical item two years ago. What do you do now?

In this situation, the Advanced Beneficiary Notice (ABN) is appropriate. 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 brace, and the estimated cost of the brace 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 brace.

If you do submit a claim to Medicare for the brace, be sure to use the GA modifier, which indicates you have provided an ABN to beneficiary.

A copy of the ABN, along with instructions for completing the form, is available here.

What to do in a situation where the original brace is broken beyond repair, no longer viable for the beneficiary or lost? Stay tuned for the next R&R post. 

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