Your Practice's Missing Piece

What is an ABN and How To Use It?

What is an ABN?  The ABN (Advanced Beneficiary Notice of Noncoverage) is a form that providers use to inform a Beneficiary that they could be finically responsible for payment based on certain circumstances.  An ABN filled out correctly as well as billing the claim with a GA modifier and used for the right reasons should move the liability of payment to the Beneficiary rather than holding the provider financially responsible.  The practice of providers using the ABN incorrectly to avoid financial responsibility is common, and is frowned on by CMS.  

Medicare prohibits the practice of a Blanket ABN, so what exactly does this mean?  A blanket ABN is defined as being used with all Medicare claims or items of service.  An ABN should only be used in certain circumstances such as; items expected to be denied for non-medical necessity, experimental items and service, same and similar items, when a supplier has no supplier number or has made a solicited contact with a beneficiary.  An ABN should not be used for reasons such as, charging a beneficiary for a component of a service when Medicare makes full payment through a bundled payment; shift liability and bill the beneficiary for the services denied due to a Medically Unlikely Edit (MUE); or to transfer liability to the beneficiary when Medicare would otherwise pay for items and services. 

Although CMS has no set time prior to date of delivery as to when the ABN should be signed by the beneficiary, it should be delivered and explained giving the beneficiary ample time to choose the option that best suits them. As providers, our main concern should be the beneficiary, we want to make sure a beneficiary fully understands what the ABN means and that they could be held financially responsible based on the option that is chosen from the ABN.  Medicare requires you keep an ABN for 5 years from the date-of- delivery when no other requirements under State law apply. Medicare also requires the provider to keep a record of the ABN in all situations, including when the beneficiary declined the care, refused to choose an option, or refused to sign the ABN

Medicare has very strict guidelines on how an ABN should be filled out.  If an ABN is filled out incorrectly and the correct modifiers are not listed on the claim than the provider runs the risk of being held financially responsible. Below are some links that CMS has provided.

How to properly fill out an ABN

Additional ABN Resources