Revenue Cycle

ABCs of ABNs

Patient Access Weekly Advisor, May 23, 2007

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Be sure to obtain an ABN under the following circumstances:

  • If you expect Medicare to deny payment (entirely or in part) for the item or service because it is not reasonable and necessary based on an NCD or LMRP (this applies to all assigned Part B items and services and to unassigned physicians' services and medical equipment and supplies).

  • If you expect Medicare will deny payment based on the frequency of the test. Certain screening tests (e.g., mammography, pap smear, pelvic exam, glaucoma, prostrate cancer, colorectal cancer) work within frequency limits.

  • If you expect Medicare to deny payment for medical equipment and supplies because it violates the prohibition of unsolicited telephone contacts or supplier number requirements.



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