Reimbursement: Don't Fall For These ABN Myths

Why This Topic Matters

ABN handling affects whether a practice can shift liability to a beneficiary, avoid improper patient billing, and reduce compliance risk when Medicare does not cover a service.

Article Sections

1. Myth 1: You Must Ask Patients to Sign an ABN for Preventive Visits

   Discusses Medicare coverage exclusions and the general circumstances in which an ABN is or is not used for preventive services.

2. Myth 2: Labs Can’t Use ABNs for Patients They’ve Never Seen Before

   Addresses routine ABN use concerns in laboratory billing and notes a CMS/OIG discussion of exceptions related to Medicare billing limitations.

3. Myth 3: You Can Double-Collect If Medicare Surprises You And Pays

   Covers situations where a claim is later paid after a beneficiary has been asked to sign an ABN, with emphasis on refund-related guidance from CMS.

4. Myth 4: You’ll Be Able to Use an ABN to Avert PECOS Ordering/Referring Denials

   Explains the topic of ordering/referring edits, PECOS-related denials, and CMS guidance on beneficiary liability in those situations.

5. Myth 5: You Need Separate ABNs for Each Day of A Treatment Course

   Summarizes guidance on ABNs used for extended courses of treatment and the general administrative limits involved.