tci ED Coding & Reimbursement Alert - 2001 Issue 8

Reader Question: Advance Beneficiary Notice

Question: Should we use advance beneficiary notices (ABNs) in the ED? Iowa Subscriber Answer: The rules for obtaining an ABN do not pertain to services furnished in an emergency room before a patient is stabilized. Medicare will pay only for services that it determines are reasonable and necessary under section 1862(a)(1) of the Medicare Carriers Manual.  ED physicians view the conflict between the Emergency Medical Treatment and Active Labor Act (EMTALA) and the ABN as a major problem. Medicare requires private practices to give beneficiaries the ABN before providing treatment if it is not covered by Medicare, but...

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