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CMS’s Medicare ABN Latest Updates: What Providers Need to Know

Event Materials (Key Required)

Medicare Advance Beneficiary (ABN) form is a written notice that you give to patients when you expect that Medicare will not pay for certain items or services. This webinar will explain the details and rules of Medicare ABNs. It can be confusing to know when you need to issue an ABN and whether it is mandatory or voluntary. If you submit the incorrect forms or make mistakes, you may face Medicare audits and penalties. In this live webinar, Expert David J. Vaughn, ESQ. will show you how and when to use the mandatory and voluntary ABN forms correctly and compliantly.

Many other payers also have similar forms and rules, so the compliance strategies you will learn in this session can apply to them as well. To protect you from unexpected charges and help you make informed decisions about your health care, Medicare requires providers, suppliers, and facilities to give you a written notice called an Advance Beneficiary Notice (ABN) before they provide items or services that Medicare may not cover. Medicare ABN is a liability waiver form and helps you avoid unpaid claims and protect your practice from serious financial and compliance risk.

Learning Objectives:
  • When an ABN must be used
  • When an ABN may be used as a courtesy
  • When an ABN should not be used
  • How to apply ABN modifiers
  • What rights the patient has when filling out the ABN
  • What if I don’t receive an ABN?
  • Know the patient / provider financial rights and responsibilities
  • Know how to properly use ABN Modifiers (GA, GX, GY, and GZ)
  • What are Non-Medicare ABNs and when to use them
Areas Covered in the Session:
  • What is an ABN?
  • CMS ABN Source Materials
  • What’s New Since Last Year?
  • What Services Do ABNs Apply To?
    • Hospital, Hospice, Home Health Agencies
    • Physicians, SNFs, Home Health Agencies
    • Part A – Inpatient
    • Part B – Outpatient
  • What Form Do You Use?
    • Physicians – CMS-R-131
    • SNFs – ABN for Part B; CMS-10055 is Part A
    • HINN – 1 – Entire hospital stay non-covered
    • HINN – 10 – Hospital requests Quality Improvement Organization to review discharge decision (can be used for MA)
    • HINN  – 11 – Non-covered items during covered stay
    • HINN – 12 – Non-covered continued stay
  • Which CMS-R-131 Form to Use?
  • Filling Out the ABN
  • Additional Considerations
  • Examples for ABN Use
  • LCD Example: Anesthesia for Upper GI Cases
  • LCD Example: Anesthesia for Pain Injections
  • No LCD Example: New Vendor Technologies
  • What About Medicare Advantage?
  • What About Commercial Payers?
  • What if No Commercial Coverage?
  • Recoupment Issues with ABNs
  • Issues with Option 1: Billing Medicare
  • Benefits of Option 2: Not Billing Medicare
  • Prior Experiences with Option 2
  • What if the Patient Refuses to Sign?
  • QMBs Cannot Use Option 2
  • Coercion
  • Prohibited Use of ABNs
  • When You Must Issue ABN
  • Modifiers
  • How Long Must the ABN be Kept?
  • Collecting & Refunding Patient Payments
  • Routine ABNs
  • ABNs for Extended Treatment
  • What if the Patient Changes their Mind?
  • Electronic vs Paper ABNs
  • Things Medicare Never Pays
  • Courtesy ABNs
  • Live Q&A Session
Suggested Attendees:
  • 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:

David Vaughn, JD, CPC, ESQ, is one of the top healthcare attorneys in the United States who is the founding member of Vaughn & Associates, LLC. He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999. David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.


Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com


This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.


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WHAT CERTIFICATION DO I GET POST THE TRAINING? +

After successful completion of the training, you will be awarded the course completion certificate (on request). The certifications/ recertifications should be mentioned under the description of every course.

TESTIMONIALS

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.”
Melissa Preston, Health Information Management Staff
“David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN”
Sandie Fowler, Out of Network Billing Staff
“Great presentation. Able to do during the day. Timing was great.”
Tina Duffy, Compliance Officer

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