Medicare ABN: CMS Updated Rules and Compliant Use

Course Description:

Medicare Advance Beneficiary (ABN) form is a written notice that you give to patients when you expect that Medicare will not pay for certain items or services. This webinar will explain the details and rules of Medicare ABNs. It can be confusing to know when you need to issue an ABN and whether it is mandatory or voluntary. If you submit the incorrect forms or make mistakes, you may face Medicare audits and penalties. In this live webinar, Expert David J. Vaughn, ESQ. will show you how and when to use the mandatory and voluntary ABN forms correctly and compliantly.

Many other payers also have similar forms and rules, so the compliance strategies you will learn in this session can apply to them as well. To protect you from unexpected charges and help you make informed decisions about your health care, Medicare requires providers, suppliers, and facilities to give you a written notice called an Advance Beneficiary Notice (ABN) before they provide items or services that Medicare may not cover. Medicare ABN is a liability waiver form and helps you avoid unpaid claims and protect your practice from serious financial and compliance risk.

Learning Objectives:

When an ABN must be used
When an ABN may be used as a courtesy
When an ABN should not be used
How to apply ABN modifiers
What rights the patient has when filling out the ABN
What if I don't receive an ABN?
Know the patient / provider financial rights and responsibilities
Know how to properly use ABN Modifiers (GA, GX, GY, and GZ)
What are Non-Medicare ABNs and when to use them

Areas Covered in the Session:

What is an ABN?
CMS ABN Source Materials
What’s New Since Last Year?
What Services Do ABNs Apply To?
- Hospital, Hospice, Home Health Agencies
- Physicians, SNFs, Home Health Agencies
- Part A - Inpatient
- Part B - Outpatient
What Form Do You Use?
- Physicians - CMS-R-131
- SNFs - ABN for Part B; CMS-10055 is Part A
- HINN - 1 - Entire hospital stay non-covered
- HINN - 10 - Hospital requests Quality Improvement Organization to review discharge decision (can be used for MA)
- HINN - 11 - Non-covered items during covered stay
- HINN - 12 - Non-covered continued stay
Which CMS-R-131 Form to Use?
Filling Out the ABN
Additional Considerations
Examples for ABN Use
LCD Example: Anesthesia for Upper GI Cases
LCD Example: Anesthesia for Pain Injections
No LCD Example: New Vendor Technologies
What About Medicare Advantage?
What About Commercial Payers?
What if No Commercial Coverage?
Recoupment Issues with ABNs
Issues with Option 1: Billing Medicare
Benefits of Option 2: Not Billing Medicare
Prior Experiences with Option 2
What if the Patient Refuses to Sign?
QMBs Cannot Use Option 2
Coercion
Prohibited Use of ABNs
When You Must Issue ABN
Modifiers
How Long Must the ABN be Kept?
Collecting & Refunding Patient Payments
Routine ABNs
ABNs for Extended Treatment
What if the Patient Changes their Mind?
Electronic vs Paper ABNs
Things Medicare Never Pays
Courtesy ABNs

Suggested Attendees:

Physician Practices
Medical Providers, who are Involved in the Payment Process of their Practice
C-Level Executives
Office Staff and Billing Managers
Medical Billing Companies
Hospital Revenue Cycle Staff
Physicians and Nurses
Physician Assistants
Nurse Practitioners
Medical Assistants
Practice Manager
Office Managers
Medical Biller, Coders and Auditors
CDI Specialists
Collection Staff
Compliance Officers
Patient Accounts Personnel
Medical Record Supervisors
Health Information Management Administrators and Technicians
Other Personnel Interested in Medicare Program and Payment System

About the Presenter:

David Vaughn, JD, CPC, ESQ, is one of the top healthcare attorneys in the United States who is the founding member of Vaughn & Associates, LLC. He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999. David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.

Additional Information:

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN"

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

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