decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Medical Necessity / When You Suspect a Service May be Denied
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Article Overview
This short Medicare compliance article is for coders, billing staff, and providers who need to understand when and how to document a patient notice for potential noncoverage. It covers the general purpose of an official ABN, basic validity requirements, and the need for clear, individualized communication before furnishing services or supplies that may be denied.
Why This Topic Matters
Proper use of the ABN affects whether patients are informed in advance about possible Medicare noncoverage and whether the notice is considered valid. This can help reduce claim disputes and compliance problems.
What You Will Learn
- The general purpose of an ABN when Medicare coverage is uncertain
- Common reasons an ABN may be considered invalid
- Why advance discussion and documentation with the patient matter
- How notices may apply to an extended course of treatment
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Compliance staff
- Practice managers
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