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ABNs and billing beneficiaries

Patient Financial Services Weekly Advisor, July 23, 2004

In most cases, you cannot bill Medicare beneficiaries for charges that Medicare denies without obtaining a signed Advance Beneficiary Notice (ABN). Two types of financial-liability provisions protect Medicare beneficiaries:

1. Medicare's Refund Requirement (RR)-Affects medical-equipment claims and nonassigned Part B claims. Nonassigned claims come from providers who have not signed a Medicare agreement. In such a case, they bill the patient directly, and the patient submits the claim to Medicare to receive payment.

2. Limitations on Liability (LOL)-Affects Part A and assigned Part B claims. Physician providers who participate in the Medicare program submit assigned claims. They accept Medicare reimbursement as full payment for care provided to Medicare beneficiaries.

So what happens if a patient refuses to sign an ABN? Under LOL, you can bill beneficiaries who demand the service but refuse to sign as long as you properly conduct and document the benefits-determination process and provide the patient with an ABN.

This means providers who inform beneficiaries of the likelihood of a Medicare denial can bill patients, even without their signature.

To document such a situation, you and a witness should sign and annotate the unsigned space on the ABN to state that the patient refused to sign the document.

However, Medicare's RR clause still protects patients who refuse to sign the ABN. Medical suppliers and physicians who do not participate in Medicare must obtain the patient's signature; otherwise Medicare will not pay for the services or items they provide.

Note: Providers can deny a service to a beneficiary who has refused to sign an ABN unless the consequences (e.g., health and safety of the patient or civil liability in the case of harm) rule out this option. Contact the ordering physician to determine whether the patient's care would be compromised by not performing the test.

This tip was adapted 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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