Beneficiary choice


I recently talked to a provider who aggressively uses the advance beneficiary notice (ABN) to upsell Medicare beneficaries. There are exceptions, but if you work for this provider and don't at least try to use the ABN on almost every transaction with a Medicare beneficiary, you'll soon be looking for another job. This is the ultimate in patient choice. You tell the  beneficiary: "Medicare pays for this wheelchair, but if you'd like this snazzier model or that, you'll have to pay extra out of pocket."

When you think about it this way, for many products, Medicare isn't all that different than other retail businesses. The patient gets what he can afford. It struck me the other day, that for many products, providers could use Medicare as lead generator, a tool to get beneficiaries into their showroom. Once they're inside, you suggest upgrades and add-on sales—just like other retailers.

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That sounds good to me.

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When it comes to retail sales, check out our special supplement in the upcoming July issue of HME News. If you want some good ideas on boosting your cash business, you'll find them here.

— Mike Moran

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The problem with that is that an ABN is ONLY to be used when a provider has a reasonable expectation that the claim will be denied. CMS statute states that blanket usage of ABN's can cause you to be audited.

Defective Notices

Routine ABN

No specific, identifiable reason to believe Medicare will not pay

Generic ABN

Stating Medicare “may not pay”

Blanket ABN

Giving ABNs for all claims for items

Signed blank ABN

Obtaining beneficiary signature on blank ABN, completing ABN later

Take the case of the Scooter Store :

In order to settle allegations that the Scooter Store submitted false claims to Medicare, the New Braunfels, Texas company agreed to pay the federal government $4 million and forego another $13 million in Medicare payments. The payments resolve several lawsuits including a whistleblower complaint from a former Scooter Store employee. The whistleblower will receive $3.2 million from the government. According to the Department of Justice, “The Scooter Store engaged in a multimedia advertising campaign to entice beneficiaries to obtain power scooters paid for by Medicare, Medicaid, and other insurers…Instead of the ‘zippy’ power scooters that were advertised, the Scooter Store sold the beneficiaries expensive power wheelchairs that they did not want, need, and/or could not use.” ”This settlement is part of our ongoing commitment to fighting abuse of Medicare’s durable medical equipment benefit,” said Assistant Attorney General Peter D. Keisler.