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

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

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:

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