Q/A: Do I Have a Patient with Part C sign an ABN if we are Out-of-Network?

by  Wyn Staheli, Director of Content - innoviHealth
Jun 22nd, 2018 - Reviewed/Updated Jan 28th

Question

Do we have to have patients with Medicare replacements that our office is not in network with sign an ABN with Option 2 marked?

Answer

Medicare Advantage (Part C), sometimes referred to as Medicare replacements, are not subject to the same rules as regular Medicare (Part B). Do NOT use the ABN for any Part C plans, regardless of whether or not you are in-network. Part C plans can have their own unique requirements regarding billing so it is necessary to find out that information from the payer. 

Be careful about balance billing rules. They can vary by state and by plan so be sure that you do NOT charge more than is allowed. CLICK HERE to read more about rules for non-contracted providers.