Advance Beneficiary Notice 101 – Ophthalmic Professional

When your office performs noncovered services for Medicare beneficiaries, you need to be transparent and keep those patients informed that they may be financially responsible. Medicare’s (CMS’) formal document designed for this purpose, an Advance Beneficiary Notice of Noncoverage (ABN), is a written notice from a health-care provider to a Medicare (generally Part B for eyecare providers) beneficiary.

CMS recommends getting a signed ABN whenever you believe that Medicare is likely or certain to deny your claim for an item or service you plan to provide. By signing an ABN, the Medicare beneficiary acknowledges that he or she has been advised that Medicare will probably or certainly not pay. The beneficiary also agrees to be responsible for payment, either personally or through another insurance (including Medicaid).

An ABN is required for both assigned and non-assigned claims. The law requires that individuals or organizations that are not registered with Medicare as a provider, such as some optical dispensaries, also use the ABN.

This article addresses the following topics regarding interpretation and report:

  • Exceptions to the necessity for an ABN
  • Customization of the ABN
  • Benficiary’s role in choosing options 1, 2, or 3

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, COE. To view the entire article in Ophthalmic Professional, click on the link below:

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