Lesson Summary

In this video, Dr. Z discusses Advanced Beneficiary Notices (ABNs) which are notices providers have to give to Medicare patients before a service is rendered when there's a probable chance Medicare may not reimburse for it. This may cover both assigned and unassigned claims.

• ABNs are for services that may or may not be covered.
• For non-covered services like a refraction, ABNs are not required.

The purpose of an ABN is to ensure the patient understands they are responsible for payment if a service is uncovered to avoid disputes about payment later on.

• If a claim is denied due to lack of an ABN, providers refund the patient.
• Patient awareness and consent are crucial, especially for higher cost procedures/services like applying an amniotic membrane.

An ABN should be signed by the patient before a procedure to make them aware and consent to being responsible for payment if Medicare denies the claim.

• Use a GA modifier on the claim to indicate potential denial by Medicare.
• ABNs include provider and patient details, information about the service, reasons for potential denial, estimated costs, and patient payment options:
• Option 1: Patient pays upfront; provider submits to insurance and refunds if paid.
• Option 2: Patient pays upfront without submitting to insurance.
• Option 3: Patient refuses the service, documenting their decision.

After signing, the patient should receive a copy of the ABN, and the provider should keep the original for records. If a denial occurs, the ABN serves as documentation that the patient was informed and agreed to be responsible for payment.