Nursing

When should providers obtain ABNs?

Staff Development Weekly: Insight on Evidence-Based Practice in Education, January 19, 2006

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An advance beneficiary notice (ABN) is a written form that you or a supplier gives to a Medicare beneficiary. ABNs inform Medicare beneficiaries that the program may not pay for an item or service used during their visit to a provider. The form allows beneficiaries to decide whether they still want to receive the item or service, even if they have to pay for it out of pocket or through other insurance.

Always present beneficiaries with an advanced beneficiary notice (ABN) in the following situations:

1. Medical-necessity denials that are determined by national coverage determinations (NCDs) and local medical review policies (LMRPs).

2. Statutory screening exams that are of limited frequency (e.g., mammograms or prostate-specific antigen testing, colorectal cancer screening).

3. Prohibition on unsolicited telephone sales calls to beneficiaries from durable medical equipment (DME) providers has been violated (by directly contacting beneficiaries, DME providers forfeit the ability to receive Medicare reimbursement).

4. Medical-equipment supplier number requirements are not met.

5. Medicare denies medical equipment and supplies in advance (no certificate of medical necessity).

6. A provider delivers home care to a patient who is not homebound and does not need intermittent nursing care.

7. A hospice provides care to a non-terminal patient.

Editor's note: The above excerpt is from the online course, "ABN Training for Hospital Staff and Physicians." For more information on this and other courses in our library, go to www.hcprofessor.com.



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