Advanced Beneficiary Notices (ABNs): What is Valid Use?
By Andrea Stark, MiraVista
In many cases, suppliers encounter situations in which patients need a specific piece of equipment or type of medical service but do not qualify for reimbursement under Medicare. Instead of dismissing the medical need, suppliers could assume the cost on behalf of the patients, which obviously cuts into profits, or utilize the powerful ABN tool, which shifts the financial burden to patients.
How can you use ABNs in your HME/DME business?
The advanced beneficiary notice is a one-page CMS form that providers give to patients before supplying items or services that are likely to be denied by Medicare. This form is completed partially by suppliers and partially by patients.
Effectively using ABNs can save your business thousands of dollars by protecting you from Medicare denials, but only if used correctly. The ABN usage is valid only if patients are notified that Medicare may deny the claim before services are provided and if patients consent to being held financially responsible.
Here are the three details that patients must understand for an ABN to be valid:
- The specific services for which they may be held financially liable (a description of the item is required, not just a HCPCS code)
- The specific reason(s) those services are expected to be denied (in terms that beneficiaries can understand)
- The amount they may expect to pay in the event of claim denial
Be mindful of how to appropriately file these forms so that you can protect your business financially and promote transparency with patients about costs they could incur.