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 the patient has when filling out the ABN
• What if I don’t receive an ABN?
• Know the patient / provider 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 in the Session

• 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 use for MA)
  • HINN – 11 – Non-covered items during 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 use 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
  • 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 – use 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

Suggested Attendees

• Physician practices
• Medical providers, who are involved in the payment process of their practice
• C-level executives
• Office staff and Billing Managers
• Medical Billing Companies
• Hospital Revenue Cycle Staff
• Physicians and Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Medical Biller, Coders and Auditors
• CDI Specialists
• Collection Staff
• Compliance Officers
• Patient Accounts Personnel
• Medical record supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Medicare Program and Payment System

About the Presenter