Anesthesia providers are required to issue an advance beneficiary notice when a service typically covered by insurance might not be covered in a certain circumstance, according to Anesthesia Business Consultants President and CEO Tony Mira.
Here are eight things to know about ABNs:
1. Medicare or other insurers might not pay if there is a question of medical necessity. For instance, an EKG as part of routine perioperative testing would likely not be covered.
2. In these circumstances, providers must issue an ABN by notifying the patient in writing and including an estimate of charges.
3. If a patient does not sign an ABN, the patient isn't responsible for the charges and the practice must take on any costs not covered by the insurer.
4. Providers should know whether there are any national coverage determinations or local coverage determinations for the service being billed. Payers could have an LCD in certain areas for some procedures.
5. An ABD isn't required for a service Medicare doesn't cover in any circumstances, but it may be provided as a courtesy to the patient.
6. If Medicare pays all or part of a claim after a patient has paid for it and signed an ABN, the provider must refund the patient. The refund typically must be issued within 30 days of notification from Medicare.
7. Consider not providing the service if a patient refuses to sign an ABN that has been correctly issued.
8. ABNs can't be presigned or issued when there is no reason to doubt Medicare will pay for a service.
Find additional insights on ABNs here.