The Advanced Beneficiary Notice (ABN) is a key tool in managing payments for Medicare patients, unfortunately, not used often or as effectively as it should be by many healthcare organizations. This applies to all, basically protecting the right to be paid for what is considered by the clinician to be a medically necessary service or procedure that may not be approved by Medicare for payment. It is an effective way to communicate with the patients about their potential financial responsibility for the service or procedure. It also is a key tool to protect the facility from audit failures. There are many parts and approaches to use of the form that need to be fully understood by many different levels within the organization. We will review the what, why, how, when to use the form and end with protection and payment for medically necessary services.
- What is an Advanced Beneficiary Notice
- Why is it necessary
- When should it be used
- How should it be used
- What happens if not done properly
- What happens if handled properly
- How to approach the patient to achieve form completion and payment for medically necessary services rendered
Areas Covered in the Session:
- What, why, when is the ABN important to the practice
- The ABN is necessary when Medicare may not reimburse for what the clinician deems to be a medically necessary service or procedure
- Liability for payment is accepted by the patient
- Patients cannot be billed if Medicare denies payment
- With a signed form the patient understands that they will be responsible for payment
- Avoid potential RAC audits for non-compliance in form utilization
- Help educate the patient about the service or procedure and their financial responsibility
- Use the form not only for initiation of treatment but if, for example, the patient demands treatment beyond what is deemed to be medically necessary
- There are many examples as to when the form should be used – not medically necessary, more treatments than believed necessary, home health
- The form is not to be used for everything!
- Billing and coding issues including proper use of modifiers
- The form is a pre-caution, if billing is done within guidelines it may not be necessary but it still must be understood as to the proper use
- The form must be completed before services are provided
- Understand the various sections of the form
- How to talk with patients about the entire process
- The form can be faxed, emailed, not only discussed face to face
- All must be aware of the “cost” to the patient – staff and patients
- Patients may refuse to sign, what do you do then?
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Who Should Attend:
- Office Managers
- Practice Manager
- Finance Manager
- Contracting Staff
- Billing Manager and Staff
- Revenue Cycle leadership
- Practice leadership
- Healthcare Staff
- Revenue cycle team
- Practice leadership
About the Presenter:
Owen J. Dahl, MBA, LFACHE, CHBC, LSSMBB, is a principal of Owen Dahl Consulting, in The Woodlands, Texas. He has 53 years of experience in consulting, running a medical billing service and managing medical practices. He was also a hospital administrator. Owen speaks across the country on medical practice issues related to strategic planning, Lean and Six Sigma, culture, human resource management and the revenue cycle.
He is an adjunct professor at the University of New Orleans, the author of Think Business – Medical practice quality, efficiency and profit, contributing author of the popular book Lean Six Sigma for the Medical Practice and recently published Integration of Behavioral Health Into Medical Homes: A Rapid Implementation Guide. Owen received his Bachelor’s degree in Hospital Administration at Concordia College, Moorhead, MN and his Master’s from the University of Northern Colorado. He recently achieved his Lean Six Sigma Master Black Belt through Villanova University. He served in the USAF.
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