tci Medicare Compliance & Reimbursement - 2014 Issue 10

Advance Beneficiary Notices: Reduce Risk Of Fraud Or Abuse Allegations

Identify services which are routinely excluded by Medicare. If you need to furnish a particular service that you know Medicare won’t cover, then an advance beneficiary notice (ABN) is the normal fall back option. Uncertain about what won’t be covered? Know these four categories of excluded items and services. Although Medicare coverage varies from state to state, there are some services that are routinely excluded. Medicare will not cover a procedure just because it has a CPT® code. Some services are statutorily excluded from coverage, while others are covered only once every year or two (for instance...

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