Recoup Lost Dollars Using an ABN

by Kimberly Pollock, RN, MBA

Obtaining a signed ABN (Advance Beneficiary Notice) can mean the difference between being able to collect on services Medicare deems "not medically necessary"--or not. The form is an important part of your reimbursement toolkit, and should follow Medicare approved guidelines.

Some tips for using ABNs:

1. Ask Medicare patients to sign one when you want to provide a service that may be denied as "not medically necessary." Examples: more than one E&M service on the same day, when one of these services is requested by the patient or family member for what may not be medically justified (such as a hearing test for sale or maintenance of a hearing aid).

2. Obtain an ABN for services that are clearly not covered by Medicare (example: facelift, hearing aid). Although Medicare does not require this, the ABN adds a reminder to patients that they are financially responsible.

3. If Medicare denies the service and you've got a signed ABN, collect your full fee from the patient, not just the Medicare allowable. You may legitimately collect this amount, according to Medicare guidelines.

4. Don't get an ABN signed unless there is some genuine doubt that Medicare may not pay.

5. Append the claim with a -GA modifier. This tells Medicare that you have an ABN on file.

Read Medicare's Official ABN Quick Reference Guide

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Download Medicare's
Approved ABN Samples

Each of these documents has been created in Microsoft Word, so you can customize them to your practice's needs.

Note: These documents have been re-created exactly as CMS approved them. They are currently missing elements that Medicare says are mandatory for ABNs, such as an option or place for the patient to deny services and a place for the witnesses' name and signature. Make sure you add these elements as you customize the form.