Medical Necessity Concepts and the ABN for Outpatient Offices
It is very important to establish a relationship with all your patients and communicate when they may be responsible for paying for healthcare services. The Centers for Medicare and Medicaid (CMS) requires physicians, practitioners, hospitals, independent laboratories, and suppliers to use the Advance Beneficiary Notice of Noncoverage (ABN) to communicate to Medicare beneficiaries if a service may be non-covered. By learning about medical necessity and following the conditions under this form, you are assured your Medicare patients are receiving complete information regarding their financial responsibilities. This course teaches you when those appropriate instances are and why it’s important to complete the ABN accurately and in a timely manner.
- At the conclusion of this course you should be able to:
- Identify how medical necessity affects healthcare coverage and payments.
- Describe the purpose of an ABN and the part it plays in Medicare.
- State when a practitioner’s office is expected to complete and present an ABN to a patient.
- Describe what constitutes a valid ABN.
- Explain the ramifications if the ABN is incorrect and submitted late.
