Medicare Advance Beneficiary Notice (ABN) - CMS Updated Rules and Guidelines 2024

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ABNs: CMS, Medicare Advantage, & Commercial Payer Rules
The Medicare Advance Beneficiary (ABN) form is a written notice that you give to patients when you expect that Medicare will not pay for certain items or services. This webinar will explain the details and rules of Medicare ABNs. It can be confusing to know when you need to issue an ABN and whether it is mandatory or voluntary. If you submit the incorrect forms or make mistakes, you may face Medicare audits and penalties. In this live webinar, Expert David J. Vaughn, ESQ., will show you how and when to use the mandatory and voluntary ABN forms correctly and compliantly.
Many other payers also have similar forms and rules, so the compliance strategies you will learn in this session can apply to them as well. To protect you from unexpected charges and help you make informed decisions about your health care, Medicare requires providers, suppliers, and facilities to give you a written notice called an Advance Beneficiary Notice (ABN) before they provide items or services that Medicare may not cover. Medicare ABN is a liability waiver form that helps you avoid unpaid claims and protect your practice from serious financial and compliance risks.
Learning Objectives:-
When an ABN must be used
When an ABN may be used as a courtesy
When an ABN should not be used
How to apply ABN modifiers
What rights does the patient have when filling out the ABN
What if I don't receive an ABN?
Know the patient/provider's financial rights and responsibilities
Know how to properly use ABN Modifiers (GA, GX, GY, and GZ)
What are Non-Medicare ABNs, and when to use them
Areas Covered:-
What is an ABN?
What's New Since Last Year?
Types of ABN
When to Issue ABN?
What Services Do ABNs Apply To?
Hospital, Hospice, Home Health Agencies
Physicians, SNFs, Home Health Agencies
Part A - Inpatient
Part B - Outpatient
What Form Do You Use?
HINN - 1 - Entire hospital stay non-covered
HINN - 10 - Hospital requests Quality Improvement Organization to review discharge decision (can be used for MA)
HINN - 11 - Non-covered items during a covered stay
HINN - 12 - Non-covered continued stay
Physicians - CMS-R-131
SNFs - ABN for Part B; CMS-10055 is Part A
Hospitals
Which CMS-R-131 Form to Use?
How MUEs affect ABNs
ABNs used in the Emergency Room
Use of ABNs to Unbundle Charges
How LCDs affect ABNs
Filling Out the ABN
Use of ABNs to shift liability to patients who have exceeded Medicare frequency limits
Additional Considerations
Patient options on the ABN form
Issues with Option 1 - Bill Medicare
The benefit of Option 2 - Don't Bill Medicare
Qualified Medicare Beneficiaries (QMBs)
Other Uses of ABNs
Prior Experiences with Option 2
Courtesy ABNs
Required vs. Courtesy ABNs
Multiple Entities Providing Care
Routine ABNs
Prohibited Use of ABNs
ABNs for Extended Treatment
Electronic vs. Paper ABNs
What if the Patient Changes their Mind?
What is the Patient Refuses to Sign?
What happens if the ABN is filled out incorrectly?
Collecting Patient Payments
How Long the ABN Must be Kept?
What are the refund rules if Medicare pays even though you have a signed ABN?
Modifiers
GA - use when you have a mandatory ABN
GX - use when you issue a courtesy ABN for items Medicare never covers; combine with GY
GY - use for statutorily non-covered items; use with GX
GZ - use when you expect Medicare to deny, and you didn't get an ABN
GK - used when upgrading a piece of equipment
GL - same as GK, but you didn't get an ABN
Things Medicare Never Pays
Do Medicare Advantage programs use ABNs
Can you use ABNs with Medicare prescription drug plans, and what ABN form must be used?
Coercion
Live Q&A Session
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