Anesthesia Business Consultants advised anesthesiologists to issue an advanced beneficiary notice of noncoverage to patients if there is "serious doubt" about whether the insurance provider will cover the requested service.
CMS designated a particular ABN form to notify patients of noncoverage for services in question. One example is in endoscopy cases where it isn't clear whether the MAC or general anesthesia is covered. However, providers should not issue an ABN if coverage isn't in question and CMS has prohibited providers from issuing ABNs on a routine basis, according to the report.
CMS is revised the official ABN form, but will not fully transition to using it until January 2021. Providers can begin using it before then if they choose.
Some commercial payers have their own notification form similar to the ABN for the patient and may require providers to submit the claim before receiving the full payment from patients. However, many do not have a set process for likely denied services and in those cases ABC recommends giving patients a form similar to the CMS ABN. The form should outline the reason for notification, show the expected out-of-pocket cost, and include a place for the patient to signal agreement, sign and date the form.