Are your ABNs up to snuff?

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Monday, September 26, 2011

BALTIMORE – Many advance beneficiary notices (ABNs) don’t meet acceptable criteria, according to a review by the CERT contractor and Noridian Administrative Services (NAS).

A bulletin posted by NAS, the DME MAC for Jurisdiction D, on Sept. 26 reminds HME providers that ABNs “must explain in beneficiary-friendly language what each item or service is, why they believe each item or service may not be covered by Medicare, and the estimated cost of the service to the beneficiary.”

The bulletin states the following are acceptable examples why Medicare may not pay for the service rendered:

  • Medicare does not pay for these tests for your condition or diagnosis.
  • Medicare does not pay for these tests for this many services (frequency).
  • Medicare does not pay for experimental or research tests.
  • Medicare does not pay for routine/maintenance services.

The bulletin also advises providers not to use a blanket statement as a reason that Medicare may not pay for the service rendered. It states the following are unacceptable reasons:

  • Services are not medically necessary.
  • Services are not covered.
  • Services may or may not be covered.

In addition, the bulletin reminds providers that the beneficiary or the beneficiary’s representative must write the date he/she signed the ABN.

To read the bulletin in full, go here.

 

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