Outpatient Facility Coding Alert - 2020 Issue 11
ABN: Update Beneficiary Notification to Protect Your Surgeon’s Bottom Line
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Article Overview
This article covers a CMS update to the Advance Beneficiary Notice of Noncoverage (ABN) form and the related instructions for beneficiaries who may have Medicare and Medicaid coverage. It is aimed at physicians, surgeons, coders, billers, and practice staff who handle beneficiary notifications and need to keep documentation current, especially when coverage uncertainty, medical necessity concerns, or frequency limits are involved. The article also reviews general ABN use, form completion, patient communication, and recordkeeping expectations.
Why This Topic Matters
Keeping ABN processes current can help practices avoid payment problems and documentation errors when Medicare coverage is uncertain. The update is especially relevant for offices that manage dual eligible beneficiaries and need to align beneficiary notification workflows with CMS guidance.
What You Will Learn
- Why CMS updated the ABN process and form guidance
- How dual eligible beneficiary instructions affect beneficiary notification
- When an ABN is generally used in relation to coverage uncertainty
- What kinds of services may prompt ABN use
- How patient communication and recordkeeping are addressed in ABN workflows
Who Should Read This
- Surgeons
- Physicians
- Medical coders
- Medical billers
- Practice managers
- Front office staff
- Compliance staff
Codes Discussed
Modifiers Discussed
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