As a general rule, Medicare expects that Advanced Beneficiary Notices (ABNs) will be issued in-person. However, there are exception protocols for delivery “other than in-person” prescribed in Chapter 30 of the Claims Processing Manual 50.7.2 – Options for Delivery Other Than In Person.(http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c30.pdf)
Per the CMS manual, ABNs can be issued via mail, telephone and even via email, BUT the linchpin is that the delivery cannot be disputed by the beneficiary to be considered valid. Having a system that enables you to affirmatively document the notification (and avoid dispute) is the most important component of this protocol. Utilization of tracking mechanisms and/or requiring signature confirmation for mailed notices, delivery confirmation receipts for emailed notices, and recordings of phone conversations can all be reliable tools where appropriate. (Just be mindful that you do this in accordance with state and federal laws as you do not want to run awry of wiretapping regulations). However, independent data collection will lessen the likelihood that your patient will successfully dispute the delivery of the ABN.
Beyond the delivery of the ABN, the CMS guidance further instructs suppliers to make follow-up attempts to collect a beneficiary signature on the ABN. These follow-up attempts need to also be documented as part of this protocol. While not required, we also recommend including a notification that they are responsible for the equipment as long as it remains in their possession; however, if they do not wish to continue accruing future monthly liabilities, they may arrange to return the equipment to avoid any new charges.
When these protocols are followed, the GA modifier should be added to claims for billing purposes once the delivery of information is confirmed (where knowledge is viably transferred and the customer is considered in possession of the information). Always maintain the documentation of both the initial delivery and follow-up attempts at collecting a signature in the patient’s file should the DME MAC request it. If theses protocols are followed you are not required to have a signed ABN to invoke the protections; however, this protocol is not effective and does not offer protections in scenarios where a supplier cannot confirm the equipment is in use, or cannot make identified contact with the beneficiary. Ultimately, in order to benefit from the ABN protections, the supplier must satisfy the burden of “informing the beneficiary” of their financial responsibility in terms that the patient can understand.
For more details about ABN protections and proper use of the ABN, please join us for an in-depth webinar: “Unraveling the Mystery of the Advance Beneficiary Notice: Harness the Protections and Profit Generating Potential of this Multi-Faceted Form” to be hosted on April 28.