ED Coding & Reimbursement Alert - 2017 Issue 9
Reader Question: Follow This Advice for ABNs
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Article Overview
This reader question addresses how advance beneficiary notices are used when there is uncertainty about payer coverage for an evaluation and management service, with emphasis on Medicare-related preventive care scenarios. It is intended for coders, billers, and practice staff who handle patient notices, compliance, and claim payment risk. The article also touches on how similar notice practices may vary by payer and why practices should confirm each payer’s requirements before billing services that may not be covered.
Why This Topic Matters
Understanding when a patient notice is needed can help practices reduce compliance risk and avoid payment disputes when coverage is uncertain. The article is useful for teams that manage preventive services, E/M billing, and payer-specific documentation workflows.
Article Sections
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Question
The opening scenario presents a patient visit in an obstetric and gynecologic setting and raises a coverage question about a notice form.
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Answer
The response explains the general purpose of an advance beneficiary notice and discusses when practices may consider it for Medicare-related E/M services. It also references preventive medicine coverage timing and the broader issue of payer liability when services are not covered.
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Extra tip
This closing note discusses using advance patient notice concepts more broadly with private payers and emphasizes confirming each payer’s preferred form and billing expectations.
What You Will Learn
- When advance beneficiary notices are considered in payer coverage uncertainty situations
- How Medicare-related preventive medicine and E/M coverage questions can trigger notice concerns
- Why payer-specific notice requirements should be confirmed before billing potentially noncovered services
- How patient notice practices may differ between Medicare and private payers
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Front office staff
- Compliance staff
- Ob-gyn practice staff
Codes Discussed
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