The ABCs of ABNs.
If providers, physicians, practitioners, and suppliers have a genuine reason to expect that Medicare will deny their claim, they should give a CMS-R-131 ABN to the Medicare beneficiary. Valid signed and dated ABNs allow the provider to bill (and collect based on the provider's current charges) the Medicare beneficiary for the denied item or service. The Medicare allowable does not pertain in those instances. An invalid ABN or no ABN prevents the provider from billing the beneficiary, and the denied services must be "written off." Providers should create a list of procedures that commonly trigger Medicare denials. Educate the healthcare team to minimally provide the required ABNs. Do not issue CMS-R-131 ABNs to every Medicare beneficiary for every item or service provided. Remember, every Medicare beneficiary visit and every service does not warrant an ABN.
Schaum
Kathleen D
KD
Kathleen D. Schaum & Associates, Inc, Lake Worth, Florida, USA. kathleendschaum@bellsouth.net
D014487:Centers for Medicare and Medicaid Services, U.S.; D039702:Current Procedural Terminology; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D006801:Humans; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D011216:Practice Management, Medical / Q000331:legislation & jurisprudence*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States