Corporate Compliance

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

Compliance Monitor, July 6, 2005

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

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.

The above tip is an excerpt from the "ABN Training Handbook for Labs," copyright 2005 by HCPro, Inc. This handbook is a training tool for helping your laboratory staff understand which services require ABNs, how to obtain an ABN, and how to discuss ABN use with physicians and others who refer patients to the laboratory. Click here for more information or to order your copy today.

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