Health Information Management

Tip: Consider whether to provide voluntary ABN

APCs Insider, March 12, 2010

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CMS’ decision allowing facilities to voluntarily provide patients with an ABN for statutorily noncovered services forces hospitals to make a decision of their own. Should they provide the voluntary ABN or not?
 
Doing so will mean that facility staff members will have only one form to deal with instead of different notices for different services. The voluntary ABNs are another way to help patients with secondary insurance that may pay for part of a statutorily excluded service.
 
Not doing so might confuse some patients, requiring staff members to spend more time educating them about the ABN. Facilities may ultimately submit more claims to Medicare for statutorily noncovered services because patients check the ABN’s “Submit to Medicare” box. Another potential problem involves the -GA waiver of liability statement issued, as required by payer policy) and -GX (notice of liability issued, voluntary under payer policy) modifiers. Medicare will deny claims when coders and billers append the wrong modifier.
 
Staffing could ultimately determine whether you provide voluntary ABNs. Determine whether your registration staff can handle distribution of voluntary ABNs—you may not have sufficient resources to do so.
 
This tip was adapted from “Should you provide a voluntary ABN?” in the March issue of Briefings on APCs.



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