Medicare is aggressively going after incorrectly paid DME claims. That means audits are on the rise, and your chances of being targeted just shot through the roof. So, if you’re not complying with Advanced Beneficiary Notice of Noncoverage (ABN) form regulations for your DME products, you risk getting hit with significant financial liability and sanctions.
Medicare’s ABN form is tricky, but add DME billing requirements and it becomes downright hazardous. Get it right, and you can collect denied funds directly from your patients. Get it wrong, and you’re left writing off tens of thousands in “not medically necessary” denials.
The problem is there are only certain circumstances when you’re required to have a patient sign an ABN for the DME products you provide. And having patients sign the form when they don’t have to can land you in just as much trouble as not getting it signed at all. You can find out how to more accurately utilize this critical and confusing form for DME by viewing this online training session presented by coding expert Leonta (Lee) Williams, RHIT, CCS, CCDS, CPC, CPCO, CEMC, CHONC, CRC, AAPC Fellow.
The only way for you to collect every penny you’re entitled to is to master the use of Medicare’s ABN form. Here are just some of the questions you’ll be able to answer after completing this how-to, step-by-step, 60-minute online training session:
- Who should be responsible in our practice for getting an ABN for DME products signed?
- What if our patient signs and then changes their mind?
- What if a patient refuses to sign the ABN?
- How long do we have to keep a copy of a signed ABN?
- How often do patients need to sign ABNs? Do they expire?
- Do we have to provide an ABN via paper, or are fax and email acceptable?
- Can we deliver an ABN by mail or does it have to be given to our patient in person?
- When am I required to refund money patients have paid?
- If I must refund money to a patient, how much time do I have?
- If I have a signed ABN for a non-covered product, do I still need to submit a claim to Medicare?
- Should we use ABNs for Medicaid patients, too?
- Do ABNs have to be issued for custom supplies?
- And so much more…
Who should watch? If you’re receiving denials or writing off charges for DME items deemed “not medically necessary,” or if you don’t have proper front-end processes in place based on coverage benefit policies, you should attend this session. For maximum benefit, attendees should possess a basic knowledge of Medicare’s billing policies and should be familiar with reporting modifiers.
Here are a few more questions that this training will help you resolve:
- How much of the standard ABN form can I customize?
- Do ABNs need to be different based on the type of product we offer?
- Are there any additional ABN requirements for continuous noncovered services?
- Am I required to have Non-Medicare patients sign an ABN too?
- How do I correctly report modifiers GA, GX, GY and GZ?
- Who is responsible for getting the ABN signed if multiple doctors are authorizing products?
- When I estimate the cost of services on the form, how close do I need to be?
- Can an ABN be issued to bill a patient for products denied due to a Medically Unlikely Edit (MUE)?
- What is a voluntary ABN?
- Can an ABN be issued on products not covered by Medicare Parts A, B, C or D?
- When an authorized representative signs an ABN instead of the patient, who is responsible for the charges?
- Do I have to use an ABN form if I’m Non-Par with Medicare?
- Can we use ABNs for noncovered portions of bundled services?
- Are ABNs different depending on the patient’s location: home, SNF, hospice, etc.?
- And so much more…
Medicare reimbursement is specific to DME items deemed “reasonable and medically necessary.” Non-covered services may not be reimbursed by Medicare, but that doesn’t mean you must take a loss in revenue. When used correctly, the ABN form transfers financial responsibility for DME products from Medicare to the patient. Medicare pays billions of dollars each year on DMEs, which means auditors are paying close attention and trying to get some of those funds back.
Without the accurate use of the ABN form for DMEs, you are risking serious financial and legal headaches. By signing up for this online training session, you’ll get the who, what, when, why and how of ABNs for DMEs. You’ll get everything you need to utilize this form correctly, ensure your compliance, and collect all the reimbursement you’re ethically entitled to for the DMEs you provide. Don’t wait, order today.
Leonta (Lee) Williams is currently the Director of Coding at a large physician organization in the southeast. Lee has over 15 years of experience working in both the outpatient and inpatient setting. Some of her professional roles have included coder, auditor, practice manager, educator, and trainer.
Lee has presented at national healthcare conferences, private healthcare training organizations, and has frequently contributed articles to healthcare publications. She currently serves on a number of Boards including Georgia Health Information Management Association (GHIMA) and the American Academy of Professional Coders (AAPC). Lee has a B.S. in Health Information Management and an MBA with concentration in Healthcare Administration.