tci Medicare Compliance & Reimbursement - 2005 Issue 19

COMPLIANCE: Inform Patients Up Front To Avoid Payment Surprises

Denials shouldn't catch anyone off guard.Just because a provider knows that not every procedure, service and test is a covered service doesn't mean that clients and patients are privy to the same information. It's the provider's job to inform the patient that he may wind up footing the bill. That's where the advance beneficiary notice comes in. ABNs are a provider's best tool for informing clients of the services and procedures they may have to pay out-of-pocket for. Problem: Constant Compliance Variances But "the regulations and covered diagnoses change all the time," making the ABN process difficult...

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