Revenue Cycle

Tip: ABN form scenario

Medicare Update for CAHs, August 24, 2011

Consider this example: A Medicare patient receives a lab test for follow-up care related to his diabetes, but by Medicare standards, the test is not considered medical necessarily for patients with diabetes. An ABN form was reviewed with the patient, but the patient refused to sign the form; stating that he still wanted the test. Two witnesses acknowledged in writing that the ABN had been presented and reviewed with the patient, and that he refused to sign it. The hospital performed the test and billed Medicare; which then denied coverage based on medical necessity guidelines. In this situation, can the hospital collect the balance due from the patient?

The answer is yes. Under the limitation on liability provisions, an ABN does not have to be signed to be effective so long as the patient was given proper notice. In cases where the patient refuses to sign and still desires the service, CMS recommends/requires that two witnesses acknowledge—in writing—that the ABN was in fact presented to the patient.

This tip was adapted from HCPro’s Medicare Boot Camp® - Critical Access Hospital Version.

Most Popular