Cash + ABN can keep non-contract suppliers in the game

Wednesday, July 17, 2013

BALTIMORE – Non-contract suppliers in Round 2 competitive bidding areas can provide service to Medicare beneficiaries if the patient agrees to pay cash and signs an advanced beneficiary notice (ABN), AAHomecare advised in a bulletin this week.

The ABN must clearly state that Medicare will not pay for specified items because the beneficiary has chosen to obtain them from a non-contracted provider.

The beneficiary then must choose whether to file the claim with Medicare or waive their Medicare rights. Such claims will be dinged with a patient responsibility code, which allows a non-contract supplier to collect from the beneficiary, the association says.

AAHomecare has confirmed this guidance with the CBIC, which expects to update its website soon.

Providers have reported to the association that beneficiaries in Round 2 areas are choosing to pay cash for needed items, either because they can’t find a contract supplier or they would rather stay with their current supplier.

Round 2 kicked off July 1 in 91 CBAs.


Why go to all that bother knowing the beneficiary won't get paid because they purchased the item from a non contract supplier?