Master Advance Beneficiary Notice Requirements and Get PAID

Length: 80 pages Expert: Owen Dahl, LFACHE, CHBC, LSSMBB CEU: 1.0

You can get barred from seeing Medicare patients altogether for incorrectly completing Medicare’s Advance Beneficiary Notice of Noncoverage (ABN) form.

Medicare is tracking everything. Who at your practice presents the form. How well you educate the patient. How you apply ABN billing modifiers. How accurately you estimate your costs. Present the wrong info and you’ll be footing the bill for thousands in unmedically necessary write offs or be left with a very angry patient that runs to Medicare to complain.

Meet all of Medicare’s ABN guidelines and you unlock thousands in patient payments. But, getting it right requires far more than just checking the correct boxes.

If you want to see Medicare patients, you really have no choice but to master ABN requirements. The good news is there is an easy way to master these confusing rules, fast. The 2019 Executive Report, Master Advance Beneficiary Notice Requirements and Get PAID, is the answer.

Here are just some of the questions you’ll be able to answer with this must-have tool at your side:

  • Should I use a mandatory or voluntary form?
  • How do we properly estimate cost?
  • Can my front desk staff give the ABN to the patient?
  • Advance beneficiary notice of noncoverage may be required for what patient?
  • Are we required to supply the ABN instructions in another language?
  • What modifier do I use if I expect Medicare to deny the claim?
  • Can we make our own version of an ABN?
  • What do we do when patients change their minds?

Don’t leave your practice liable for unnecessary bills, significant fines and even restriction from seeing Medicare patients. Armed with this executive report, reviewed by national ABN expert Owen Dahl, MBA, LFACHE, LSSMBB, you’ll be able to protect reimbursement, train employees and improve compliance without spending weeks – or months – sifting through the ABN form requirements yourself.

The actionable steps and tools you’ll access inside this step-by-step report will help you comply with ABN rules, collect more of the reimbursement your owed, and avoid CMS backlash for incorrect usage. This report dives into the nitty-gritty, real-world questions you need answered:

  • What are LCDs and NCDs and why do they matter to ABNs?
  • What’s the difference between statutorily excluded services and non-covered services?
  • What’s the difference between modifier GX and EY?
  • What modifier applies when I need an ABN for a Medically Unlikely Edit?
  • Who Is qualified to issue the ABN?
  • What do we do when the physician wants more treatments than allowed?
  • Must the form be given to the patient face-to-face?
  • How long do I need to keep the ABN after the patient signs it?
  • When do I use modifiers GA, GX, GY and GZ?
  • Can I issue and ABN without an ICD-10 code?
  • What exactly does CMS require me to say to the patient?
  • How can you identify when a service or item may not be covered?
  • Who’s authorized to sign the ABN for an incapacitated patient?
  • What does “medically necessary” really mean?
  • How do I handle authorized representatives?

The Master Advance Beneficiary Notice Requirements and Get PAID Executive Report is chocked full of forms, modifier cheat sheets, and expert Q&A. This one-stop resource will provide you with everything you need to successfully complete, administer and maintain Medicare ABNs to help you get paid. Check out these must-know report chapters:

Chapter 1:  ABN What, When, Why and Where

Chapter 2:  Identifying Non-Covered Medicare Services

Chapter 3:  How the ABN Applies to Durable Medical Equipment

Chapter 4:  ABN Form Completion

Chapter 5:  Modifiers for ABN-Related Services

 Quick Reference Time Savers:

  • ABN Modifier Cheat Sheet
  • Expert Answers: ABN Questions
  • Definitions —Fast and Easy
  • Acronyms – Helpful and Handy

Forms Toolkit:

  • ABN English Form
  • ABN Spanish Form
  • Checklist for ABN
  • Non-Medicare Financial Waiver

Not only will you be able to answer the top ABN compliance questions, you’ll also be able to apply the practical knowledge to your everyday situations. This expert report’s breaks down the ABN process, even explaining tricky definitions to help you master the nuances of this challenging form. Here are some of the concrete examples you’ll see throughout the book.

The terms “statutorily excluded services” and “non-covered services” are sometimes used interchangeably, which can make it difficult to determine whether an ABN is mandatory or voluntary. Why? All statutorily excluded services are non-covered, but not all non-covered services are statutorily excluded. Non-covered services are those that do not meet coverage criteria for some reason. Being excluded by statute is one of those reasons, but there are also other reasons, such as not meeting medical necessity. Statutorily excluded services are specifically excluded from the Medicare program — they are not a recognized Medicare benefit. So, you can view them as a subset of non-covered services.

Example 1 Excluded Service: Dental care (example: filling a cavity) is a statutorily excluded service — it is not a recognized Medicare benefit. A dentist would not need to issue an ABN in this situation.

Example 2 Non-Covered Service: In contrast, a depression-screening could, in some cases, constitute a non-covered service. Medicare normally covers one depression screening per year if done in a primary care setting. If a beneficiary undergoes a screening in a psychiatrist’s office, Medicare would not cover that screening because it does not meet the coverage guidelines of a primary care setting. The psychiatrist should issue an ABN before providing the screening.

Want more? Order this executive report now! You’ll have all the info you need to tackle ABNs and keep your Medicare patients rolling in.


Meet Your Expert

Owen Dahl
LFACHE, CHBC, LSSMBBPrincipal of Owen Dahl Consulting

Owen is a principal of Owen Dahl Consulting, in The Woodlands, Texas. He has 53 years of experience in consulting, running a medical billing service and managing medical practices. He was also a hospital administrator. Owen speaks across the country on medical practice issues related to strategic planning, Lean and Six Sigma, culture, human resource management and the revenue cycle.

He is an adjunct professor at the University of New Orleans, the author of Think Business – Medical practice quality, efficiency and profit, contributing author of the popular book Lean Six Sigma for the Medical Practice and recently published Integration of Behavioral Health Into Medical Homes: A Rapid Implementation Guide. Owen received his Bachelor’s degree in Hospital Administration at Concordia College, Moorhead, MN and his Master’s from the University of Northern Colorado. He recently achieved his Lean Six Sigma Master Black Belt through Villanova University. He served in the USAF.