Health Information Management

Q/A: ABN for multiple visits for infusion services

APCs Insider, June 8, 2012

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Q:  Our infusion patients are complaining because we have them sign an advance beneficiary notice of noncoverage (ABN) on each visit because it is for the same drug and infusion service.  Can they can sign an ABN that will cover multiple visits?

 
A:  Yes, you can issue an ABN for multiple visits as long as the services and the time frame are specified.  CMS regulations require that an ABN be issued for a specific procedure/test/service. If an additional service is ordered that Medicare does not cover, the patient must sign an additional ABN for that service before the service is provided.  For example, the patient has signed an ABN for a drug infusion service for a period of three months. The physician orders a lab test for a date during the second month of therapy and the lab test is non-covered, the patient must sign an ABN specific for the lab test before the service is provided. 
 
CMS posted “Advance Beneficiary Notice of Noncoverage (ABN)” on the Medicare Learning Network
 
That document includes the following information:
 
ABN FOR AN EXTENDED COURSE OF TREATMENT
A single ABN may be issued to cover an extended course of treatment if the ABN identifies all items/services and the duration of the period of treatment for which the health care provider/supplier believes Medicare will not pay. If an item or service is provided during the course of treatment that is not listed on the ABN and may not be covered by Medicare, a separate ABN must be issued.
A single ABN for an extended course of treatment is valid for no more than one year. If the extended course of treatment will continue after a year’s duration, a new ABN must be issued.
 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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