Medicare Advance Beneficiary Notice (ABN) – CMS Updated Rules and Guidelines

Medicare requires ABNs if a patient is to be billed for a non-covered service; Medicare Advantage programs do not use ABNs; commercial insurers do not use ABNs. This webinar will explore how to bill for non- covered services for Medicare, Medicare Advantage, and commercial insurers. There are numerous rules as to when ABNs can and cannot be used and how they need to be filled out and whether any changes to the ABN form can be made. Patients have a right to choose 3 options on the ABN; we will explore when each option is applicable. ABNs have specific modifiers that are required, and this webinar will explore when each modifier is used, and its effect. There are special rules for QMBs that will be addressed. We will explore what happens when a patient refuses to sign an ABN, and if it signed, when it must be signed and how long it must be kept.

Learning Outcomes:

The goal of this webinar is to educate providers regarding how to bill for non-covered services using ABNs and similar documents when the patient has Medicare, Medicare Advantage, Medicaid, commercial insurance, and no insurance at all. We will explore what forms must be used, and what forms cannot be used, and the rules surrounding these forms.

Areas Covered in the Session:

• When is an ABN used and when is it not used
• What are the ABN modifiers and when is each used
• Examples of ABN usage
• When does the ABN have to be signed
• How long must the ABN be kept
• What form are required in lieu of ABNs for Medicare Advantage
• What forms are required by commercial insurance and Medicaid
• What forms are required if the patient is uninsured
• What to do if the patient refuses to sign the ABN
• What are the rules for QMBs (Qualified Medicare Beneficiaries)
• What are the pros and cons of using Options 1, 2, and 3 on the ABN
• Which ABN form must be used
• What happens if the patient signs the ABN but then changes their mind
• How to use ABNs for extended treatments for non-covered services
• Refunding patients upfront payments
• Can retroactive ABNs be procured
• How to fill out each field of the ABN
• Different types of ABNs for Part A vs Part B
• Do ABNs apply to Medicare Parts C and D
• Are electronic ABNs allowed, or must they be paper
• Recognize the implications of issuing courtesy ABNs for services never covered by Medicare
• Identify the differences between mandatory and voluntary ABNs and their appropriate usage
• Understand the protocols when multiple entities are involved in patient care regarding ABN issuance
• Recognize situations where routine ABNs are prohibited and the importance of individualized notices
• Understand the process for collecting patient payments when an ABN is in place
• Know the refund rules if Medicare pays for a service despite a signed ABN
• Understand the importance of accurate ABN completion to avoid claim denials and compliance issues
• Recognize the potential consequences of coercing a patient into signing an ABN
• Explore the use of ABNs in scenarios involving upgraded equipment or services
• Understand the role of ABNs in protecting providers from allegations of non-compliance and recoupment
• Discuss common misconceptions and pitfalls associated with ABN usage
• Engage in a live Q&A session to address specific questions and scenarios related to ABNs
• Live Q&A Session

Recommended participants:

• Physician Practices
• Medical Providers, who are Involved in the Payment Process of their Practice
• C-level Executives
• Office Staff and Billing Managers
• Medical Billing Companies
• Hospital Revenue Cycle Staff
• Physicians and Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Medical Biller, Coders and Auditors
• CDI Specialists
• Collection Staff
• Compliance Officers
• Patient Accounts Personnel
• Medical Record Supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Medicare Program and Payment System

Presenter Biography: