Corporate Compliance

Tip: Ensure ABN compliance with regular auditing

Healthcare Auditing Weekly, January 13, 2009

Follow these tips to audit the use of advance beneficiary notices (ABNs) in your facility and ensure all staff members understand the new rules and instructions:

  1. Review updated policies. Make sure your facility implements updated policies to comply with CMS’ new Claims Processing Manual instructions. Query staff members to determine whether the facility has developed these new policies and if staff members understand them. Ensure staff members understand the new rules and know when to complete the new ABN.
  2. Check cost estimates. One of the major changes to the new ABN concerns the cost estimate providers give beneficiaries. The new form requires a good faith cost estimate and the new manual instructions are more specific, requiring an estimate that is within $100 or 25% of the actual cost.
  3. Find a legal representative. CMS’ new instructions require a patient’s legal representative/guardian sign the ABN if the patient is incapacitated. Previously, anyone acting on the patient’s behalf, and who did not have a conflict of interest, could sign for the patient.
  4. Examine the details. ABNs require a description of the service the patient needs and a reason why Medicare may not cover it. Staff should be thorough and clear when completing the form. Look at the description from a beneficiary’s point of view—is it decipherable to someone who may not have a medical background?
This tip is an excerpt from an article published in the December 2008 issue of the HCPro monthly newsletter Healthcare Auditing Strategies titled “New CMS rules for ABNs require auditing.” For more information about this newsletter visit the HCMarketplace.


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