Re: Are we required to take Medicare patients? (The ABN part)

[Guest guest]

Rick,

Re: ABN (Advanced Beneficiary Notice)

Regarding the ABN, I thought that was only for the charges that we had to give notice that Medicare is UNLIKELY to pay so they have to sign an advanced notice that they understand this; the government protecting consumers from doctors.

Therefore, an ABN would NOT be necessary if we are billing for spinal adjustments; (notwithstanding the fact that in reality, Medicare may not pay for anything-ever).

I copied this from WPS website:

Advanced Beneficiary Notice (ABN) - What is it all about?

Home Provider Part B Publications

Editors Note: This is the first in a series of articles explaining the " ins-and-outs " of the ABN. Watch our Website and Listserv for future articles.

An ABN is a written notice given to a Medicare beneficiary by a physician, provider, or supplier when he or she believes that Medicare will not pay for some or all of the services or items primarily on the basis of not being medically necessary. The ABN is not designed for use when Medicare never covers a service. An ABN should be used if Medicare does cover the service for some diagnoses, but the provider's believes it will not be covered for a particular situation.

Medicare Part B has two different forms for providers to use. The ABN-G is a general notice that may be used for any service that the provider believes Medicare will not pay for based on Medical Necessity. The ABN-L is a notice for use by laboratory services only. The labs can use either an ABN-G or ABN-L.

How does an ABN protect a beneficiary?

• Allows a Medicare beneficiary to make an informed consumer decision about whether or not to receive the services or items for which he or she may have to pay out-of-pocket or through other insurance

• Allows the beneficiary to better participate in his or her own health care treatment decisions

• Protects the beneficiary from unexpected financial responsibility when Medicare is unlikely to pay for a particular service

How does an ABN protect a provider?

• Allows the provider to collect payment from the patient if the Medicare deems a service to be not medically necessary

• Provides provisions for patient refusal to sign the ABN

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: <RMBALSIGER@...>

Date: Tue, 15 Jan 2008 14:10:22 EST

<deadmed@...>, <skrndc1@...>, <billhartje@...>, < >, <kjholzdc@...>

Subject: Re: Are we required to take Medicare patients?

Doc, My understanding is you can see them, have them pay you no more than the limiting charge but you are required to bill medicare on their behalf and you better have the ABN filled out for each visit or medicare can require you to refund for visits that medicare determines are not medically necessary. Please correct me if I'm wrong. Another consideration that I'm running into is that some of my patient population that I have seen for many years are aging and billing medicare is becoming a necessity for my office if I'm going to continue to see these people.

Rick

M. Balsiger, Jr., D.C.

Balsiger Chiropractic Center

1019 N.E. 122nd Avenue

Portland, Oregon 97230

503 257-8606

Start the year off right. Easy ways to stay in shape <http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489> in the new year.

[Guest guest]

, It's my understanding that they may find some spinal adjusments "not medically necessary" and therefore subject to refund to the patient. For instance, what if they should decide that a given visit and adjustment were for maintenance rather than for curative purposes. I know that medicare says it is not necessary for every visit but I think it is a "CYA" situation.

Rick

M. Balsiger, Jr., D.C.

Balsiger Chiropractic Center

1019 NE 122nd Avenue

Portland, Oregon 97230

503 257-8606Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Got it.

It probably would be good to get pts. To sign an ABN every visit like the life saving, “Did anyone give you some luggage to take with you to the airport?”

We will begin doing this with every Medicare patient.

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: <RMBALSIGER@...>

Date: Tue, 15 Jan 2008 20:48:02 EST

<drscott@...>, <deadmed@...>, <skrndc1@...>, <billhartje@...>, < >, <kjholzdc@...>, <info@...>

Subject: Re: Are we required to take Medicare patients? (The ABN part)

, It's my understanding that they may find some spinal adjusments " not medically necessary " and therefore subject to refund to the patient. For instance, what if they should decide that a given visit and adjustment were for maintenance rather than for curative purposes. I know that medicare says it is not necessary for every visit but I think it is a " CYA " situation.

Rick

M. Balsiger, Jr., D.C.

Balsiger Chiropractic Center

1019 NE 122nd Avenue

Portland, Oregon 97230

503 257-8606

Start the year off right. Easy ways to stay in shape <http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489> in the new year.