ED Coding & Reimbursement Alert - 2012 Issue 22
Billing: Performing Non-Payable Services for Private Insurers? Consider This ABN-Style Waiver
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Article Overview
This article discusses billing workflow considerations for services that may not be reimbursed by private insurers, with comparison to Medicare ABN practices. It focuses on patient notification, financial responsibility language, payer-specific guidance, and the use of waiver-style forms for potentially noncovered services. The content is aimed at practice managers, billers, and coders who need to reduce denied claims and avoid patient billing surprises.
Why This Topic Matters
It helps practices understand how to document patient financial responsibility before performing services that a payer may deny, which can support cleaner billing processes and better patient communication.
Article Sections
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Don't Skip ABNs for Private Payers
Introduces the use of advance-notice waiver documents for non-Medicare patients when coverage is uncertain. Discusses patient communication and the general purpose of pre-service notification.
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Avoid Relying Solely on Global Financial Policies
Covers how a practice-wide financial policy fits with separate notice forms for specific services. Focuses on general patient responsibility language and the relationship between broad policies and service-specific notices.
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Follow Payer-Specific Guidelines When Available
Describes situations where payers provide their own guidance on when advance-notice forms are expected. Includes mention of payer-specific examples and general reminders about using waiver-style documents when coverage is doubtful.
What You Will Learn
- How waiver-style notices are used when private coverage is uncertain
- How global financial policies relate to service-specific patient notices
- How payer-specific guidance can affect documentation practices
- How practices communicate potential patient responsibility before a service is performed
Who Should Read This
- Medical practice managers
- Medical billers
- Medical coders
- Front-office staff
- Revenue cycle teams
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