ABN: It's time to take another look

Monday, July 31, 2006

For years, nervous providers wary of some kind of Medicare reprisal have ignored the advanced beneficiary notice, a.k.a the equipment upgrade provision. But with competitive bidding on the horizon, the time has never been better to take a new look at the ABN, say industry watchers.
The ABN allows providers to upgrade a piece of equipment and charge beneficiaries the difference between what the upgrade costs and what Medicare pays.
As part of the process, a provider explains in advance why an item may not be covered and what the cost may be to the beneficiary, said Dave Williams, an industry consultant.
"In that way, the provider secures for themselves the right to bill for the balance of that item," said Williams. "It might be the full amount, it might be a partial amount."
The June HME News Poll showed that slightly more than half of respondents used ABNs less than 10% of the time. Only a tiny percentage--7.7%--used them more than 60% of the time.
Providers have historically shied away from ABNs since their inception in 2002, in part because they fear accusations of upselling. They also don't want payments delayed because of possible errors, said Williams.
Providers should have been using ABNs all along, said Miriam Lieber, an industry consultant based in Sherman Oaks, Calif.
"Use ABNs generously and make sure that what you're doing is accurate," Lieber said. "Make sure employees are using them accurately."
Lieber said she sees many mistakes--missing dates, forgetting the beneficiary's signature--that invalidate ABNs. Above all, she says, be specific when explaining why a particular product can be billed using an ABN.
"Be flowery when writing your reason," said Lieber. "In this case, more is better."
Being specific benefits both the provider and the beneficiary, agrees Dr. Robert Hoover, former Region D medical director.
"When you have an explanation for a beneficiary that's very general or vague, it doesn't really serve the purpose of notifying them exactly what Medicare is not going to pay for," said Hoover. "In addition to insulating the dealer from liability, it properly informs the beneficiary so there are no surprises in the bill."
In other words, listing "Medicare probably won't pay for this" as the reason for the ABN is not sufficient, experts said.