Corporate Compliance

Are facilities required to provide ABN’s? If so, please cite the regulation.

Compliance Monitor, March 11, 2005

A: The regulations speak to the need to issue an ABN under certain circumstances, in order to hold the patient responsible for the services. Not issuing ABNs is not specifically addressed except for the fact that facilities cannot hold the patient liable for services denied for medical necessity.

There is a risk when electing not to issue ABNs: the hospital could be considered to be knowingly providing free services to patients and this is not acceptable to Medicare. It could be construed along the same lines as waiving deductibles and copays.

Many facilities are issuing ABNs in some areas but not others, most notably in the emergency room. There is a lot of controversy about whether this is an appropriate site and whether it can be determined before the service that it is not medically necessary. Whatever policy you adopt for your facility, you should have adequate procedures in place to administer it.

Since the volume of LMRPs, as well as the services affected will continue to increase, the financial impact of lost revenue can become significant for hospitals and not issuing ABNs may prove costly.

To learn more from CMS' Web site, click here and scroll down to "Advance Beneficiary Notice [ABN]."

This question was answered by Joyce Sourbeck MS, RN, assistant vice president for patient financial services, Washington (DC) Hospital Center.

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