A required ABN is issued under the following circumstances:
- lack of medical necessity (this includes not meeting coverage criteria in a LCD, or where there is indication of same or similar equipment, among other scenarios),
- denial of an Advanced Determination of Medicare Coverage (ADMC),
- operating without a supplier number, and
- prohibited, unsolicited telephone contacts in violation of supplier standards.
Waiver of Liability Statement Issued as “Required” by Payer Policy.
Alternately, a voluntary ABN should be used in instances when the item is expected to deny for statutory reasons. Typically the items will be classified as non-covered. While the voluntary ABN is more educational in nature and does not impact financial liability, it must still meet the compliance criteria of required ABNs.
Voluntary ABNs should be communicated to Medicare using the GX modifier, defined as:
Notice of Liability Issued, “Voluntary” Under Payer Policy.
When used correctly, ABNs can effectively reduce risk and increase cash collections – but you have to do it the right way. Do you have more questions about the ABN? Channel Goldilocks and learn how to craft ABNs to Medicare’s discerning taste by joining Andrea Stark for The ABN: Getting It “Just Right” on Tuesday, Oct. 27 at 2 p.m. Eastern. Reserve your seat today!