Corporate Compliance

Note: CMS provides guidance on voluntary use of ABNs

Medicare Insider, December 1, 2009

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Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

In a recent transmittal (R1840CP), CMS provides guidance on the voluntary use of ABNs.  ABNs are prescribed forms of liability notification that are provided to beneficiaries prior to the delivery of outpatient services in circumstances where the provider believes that Medicare will deny coverage, resulting in beneficiary liability for those services. Prior notice is generally mandatory when the provider expects Medicare to deny coverage for any of the following reasons:

  • The services do not meet Medicare’s medical necessity guidelines for those services;
  • The services are screening services that are being provided more frequently than Medicare provides a benefit for; or
  • The services are custodial in nature.

Click over to the MedicareMentor Blog to read more.



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