BILLING: You Can't Use ABNs To Collect Extra From Patients

Why This Topic Matters

Incorrect ABN use can create compliance risk, billing errors, and improper patient charges. Understanding the limits of ABNs helps practices handle Medicare coverage issues appropriately and avoid overuse.

Article Sections

1. Myth #1: When an ABN Should Be Used

   Explains the first common misconception about ABN use and contrasts covered services with situations involving Medicare coverage limitations. The section also discusses claim handling in general terms for services that are not covered in a particular instance.

2. Example of Medicare Coverage Limits for a Service

   Uses a clinical scenario to illustrate how Medicare coverage concerns can arise even when a service is clinically considered. The section also references preventive service frequency limits.

3. Myth #2: ABNs and Extra Patient Charges

   Addresses the misconception that ABNs allow billing above Medicare payment amounts. The section focuses on participation status and restrictions on patient cost sharing beyond the allowed amount.

4. How Often ABNs Should Be Used

   Discusses whether frequent ABN issuance may indicate a problem with workflow or claim denials. The section emphasizes monitoring patterns and reviewing repeated denials.

5. Bottom Line

   Summarizes the overall compliance theme of the article and reinforces that ABNs are intended for limited use.