Industry advocates: The time is right to rethink the ABN option

Wednesday, March 31, 2004

The Advanced Beneficiary Notice - intended to be a lever for Medicare equipment upgrades - hasn’t really caught on with providers since its inception a couple years ago. But with the Medicare Prescription Drug Act promising to seal off conventional revenue paths, it may be a good idea for providers to give the ABN another look, industry advocates say.
Dave Williams

In describing their reticence to use ABNs, providers say the main obstacles have been the fear of triggering an audit, complicated billing rules, documentation wariness and concerns about beneficiary confusion. In a March 2002 HME News Reader Poll, only 12% of respondents said they had filed an ABN.

ABN architect Dave Williams concedes the upgrade option has been underutilized so far but that there are signs it could gain new life.

“It’s shaking itself out now - the opportunity is being recognized,” said Williams, an Amherst, Ohio-based legislative and regulatory affairs consultant. “Those who have dipped their toes in are getting more comfortable with it. High-end rehab providers are starting to use it a lot.”

Michael Mayfield, vice president of operations for Signature Healthcare in Lutherville, Md., was among the respondents who expressed reservations about the ABN in the March 2002 poll. He has altered his stance somewhat since then, but remains cautious.

“We are using it, but we’re proceeding very carefully,” he said. “Our scope right now is limited because we don’t want to open the wrong doors.”

Still, beneficiaries are intrigued by the ABN concept and are receptive to using it for certain products, like rollators, Mayfield said.

“They are actually disappointed that the option wasn’t available before,” he said. “It has definitely improved our walker business. We just don’t want it to look like we’re pushing products on patients.”

That’s a prudent approach, noted Cara Bachenheimer, vice president of government affairs for Elyria, Ohio-based Invacare.

“It has to be an open process and everything needs to be thoroughly explained,” she said. “Beneficiaries have to see for themselves that it’s a way to improve their lifestyle. They have to walk away happy. Don’t let them think they were talked into it.”

Audit fears, while grounded in reality, shouldn’t be a barrier to ABN participation, Williams and Bachenheimer said.

“I would hope providers can get over their inhibitions,” Bachenheimer said. “These fears aren’t justified. There is a lot of confusion about ABNs and there is no question that the DMERCs could do audits, but I haven’t run across anyone who has been audited for using ABNs.”

Williams agreed that the risk of getting audited is slight.

“Investigators have bigger fish to fry,” he said. “I doubt that aggressive audits of ABNs is even on their radar screen.”

The best defense against a potential audit is to have procedures in place that detail every step of the transaction, Williams said.

“Develop formularies for each code,” he said. “For a K0011, for example, create a formulary that explains what is provided and what is included in the upgrade. Have the beneficiary or medical guardian sign off on it to show they understand.”

By keeping fastidious records and showing restraint in dealing with patients, an ABN transaction should go off smoothly, Bachenheimer said.

“You just have to be extra communicative on this process,” she said. “You don’t want the patient to think you sound desperate. Just be smart and show them how paying extra for a product will really help them.”