![]() ![]() Statutorily Excluded items are services that Medicare will never cover, such as (not a complete list): Statutorily Excluded service/procedure (non-covered service).The typical reasons that Medicare will not cover certain services and that would be applicable are: In the past, Medicare had a “Notice of Exclusion of Medicare Benefits” (NEMB) that we could provide to the patient (no signature required) to alert them of Medicare’s non-covered services. ![]() With a signed ABN, the practice has proof of the patient’s informed consent to provide the service and their agreement to be financially responsible for the service. You do not have to reduce your charge to the Medicare allowable. You may also charge the patient 100 percent of your fee. If the patient signs the ABN and is made aware of their financial responsibility you may require the patient to pay for this service on the date the service is provided. It is, however, a good idea to have the ABN signed for non-covered services so the patient is made aware that they are responsible. In this case, a practice can bill the patient for the non-covered service despite not having an ABN. The only exception is for statutorily excluded services (those that Medicare never covers like cosmetic surgery and complete physicals for example). If the practice does not have a signed ABN from the patient and Medicare denies the service, the charge must be written off and the patient cannot be billed for it. The use of the ABN is required by Medicare to alert patients when a service will not be paid by Medicare and to allow the patient to choose to pay for the service or to refuse the service. The patient is in the exam room or the lab, ready for the service or test, and a knowledgeable staff person must step in, explain the rules and pricing and obtain the patient’s signature.īlogger Charlene Burgett does a great job of explaining the ins and outs of using the ABN, and has agreed to share an article originally published on her blog “Conundrum” with MMP readers. It is particularly difficult to determine who has ownership of this process, because the form must be completed and signed by the patient before the service is provided. Note from Mary Pat: The Advance Beneficiary Notice of Noncoverage (ABN) is a collection tool that many medical practices do not know how to implement. There’s a new ABN form required to be in use in January 2012 – read about it here in my article “Everybody’s Favorite Form: New Advance Beneficiary Notice of Noncoverage (ABN) Form Begins in 2012” ![]()
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