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Tip: What to do when patients won't sign an ABN

Patient Financial Services Weekly Advisor, July 29, 2005

Under Medicare's Limitations on Liability provision, providers can bill beneficiaries who refuse to sign the advance beneficiary notice (ABN) but who demand the service as along as staff properly conduct and document the benefits-determination process and provide the patient with an ABN. That is, 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 second witness should sign and annotate the space designed for the beneficiary's signature on the ABN to state that the patient refused to sign the document.

However, Medicare's Refund Requirement 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 or Medicare will not pay for the services or items they provide.

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.

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