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Tip: ABN do's and don'ts

Patient Financial Services Weekly Advisor, June 11, 2004

Advance beneficiary notices (ABN) have long been a source of confusion and stress. Here are some explanations for when you should-and shouldn't-obtain one.

Do get one signed if

1. you expect Medicare to deny payment (entirely or in part) for an item or service because it is not reasonable and necessary based on a national coverage decision (NCD) or local medical review policy (LMRP). This applies to all assigned Part B items and services and to unassigned physicians' services and medical equipment and supplies.

2. certain screening tests (e.g., mammography, Pap smear, pelvic exam, glaucoma) work within frequency limits. Obtain an ABN when you expect Medicare to deny payment due to the frequency of the test.

3. you expect Medicare to deny payment for medical equipment and supplies that violate the prohibition on unsolicited telephone contacts or supplier number requirements

You do not need to obtain an ABN if

1. the physician or supplier expects Medicare to pay (e.g., if the test or service meets medical necessity requirements of NCDs or LMRPs)

2. the physician or supplier claims to never know whether Medicare will pay for a test or service

3. the item or service is not a Medicare benefit, such as a routine physical or tests in the absence of signs and symptoms

4. Medicare is expected to deny payment for an item or service that is a Medicare benefit because it does not meet a technical benefit requirement, such as diabetic care shoes not prescribed by a podiatrist

This tip was excerpted from the ABN Training Handbook for Hospital Staff and Physicians by Stacie L. Buck, RHIA, LHRM. Copyright 2004 by HCPro, Inc. For more information, click here.

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