ABNs Are Being Used More Frequently – Required for Non-assigned Claims? Maybe.
Billing, Reimbursement, Audits and Compliance
on August 27, 2018
By Ronda Buhrmester, Director of Reimbursement, VGM & Associates
Does Medicare require ABNs for non-assigned claims? The quick answer is MAYBE – depends on the situation. Let’s start with some misconceptions in the industry about non-assigned claims.
One misconception is that a supplier has no financial liability and needs to get an ABN for non-assigned claims. Essentially, non-assigned means that the supplier is not accepting the Medicare fee schedule because the reimbursement is too low.
The explanation the supplier provides on an ABN for a non-assigned claim cannot be “claim is being submitted as non-assigned.” With a non-assigned claim, there still is financial liability, meaning the supplier needs to make sure the coverage criteria has been met according to the medical policy. If the coverage criteria is not met, this is when an ABN is implemented whether it’s an assigned claim or a non-assigned claim.
The purpose of an ABN is to inform a beneficiary in advance of the reason Medicare may not pay for the service being provided. If the supplier puts “claim is non-assigned” as the reason for denial on the ABN, it’s not a valid reason and will be denied in an audit. ABNs are used for the following situations:
- Lack of medical necessity
- Same or similar equipment
- The quantity exceeds the allowed amount
- Upgrades (not within the same code)
Remember, the ABN speaks to the beneficiary, making sure they understand the information documented on the form. The ABN allows the beneficiary to make an informed, consumer decision about whether or not to receive the services for which they may have to pay out of pocket.
ABNs do get audited. If not used properly and completed as instructed, an ABN will cause an unfavorable decision in an audit. Be sure to review the ABN instruction manual with your staff.
Please contact me with any questions.
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