The Limitation on Liability (LOL) protection of §1879 of the Act apply only when a provider believes that a Medicare covered item or service may be denied in a particular instance because it is not reasonable and necessary under §1862(a)1) of the Act or because the item or service constitutes custodial care under §1862(a)(9) of the Act. This requires a provider to notify a beneficiary in advance when s/he believes that the items or services will likely be denied either as not reasonable and necessary or as constituting custodial care.
Everyone who bills Medicare knows that there are times when the provider must give a patient an advance beneficiary notice. When a practice fails to issue an ABN, it will likely be stuck with the cost of the denied service and it can not ask the patient to pay. But, issuing an ABN is easier said than done and "the burden of proof is on the provider to show that the ABN was conveyed according to CMS instructions," Lewis writes in her presentation.
Knowing when a patient needs an ABN is less than half the battle. Lewis outlines several ABN conundrums a practice may encounter, including:
- The ABN needs to cover a series of services.
- The ABN can't be delivered in person.
- The patient refuses to sign an ABN.
- The patient changes his mind after completing an ABN.
And there's still more to the process. Gather your team and get all the details and answers to the ABN questions that have been snarling your claims on
Thursday, Jan. 24, 1 - 2 p.m., ET.
There is no limit on the number of people who can listen to and receive CEUs for attending our webinars, and the price includes on-demand access to a recording.