July 23, 2012
The basic purpose of Section 1879 of the Social Security Act, the limitation of liability provision (ABN) is to protect the beneficiaries (Patients) from liability in denial cases under certain conditions when items they receive are found to be excluded from coverage as NOT reasonable and necessary under section 1862 (a) (1) (A) of the Federal Security Act.
Where items or services are denied because they are determined to be not reasonable and necessary, the Medicare program makes payment when neither the beneficiary (patient) nor physician or supplier knew, and could not reasonably be expected to know, that the items or services were excluded.
When the beneficiary did not have such knowledge, but the physician or supplier knew, or could have been expected to know of the exclusion of items or services, the liability for the charges for the denied items or services rests with the physician or supplier.
If an ABN is not presented to the patient for those services or supplies that day prior to those services, the doctor will not be reimbursed by the Medicare Carrier if a participating provider and can not receive payment from the patient, or as a non-participating provider, the denial EOB will tell the patient to return to the doctor for a refund of what they paid at time of services.
The bottom line....the ABN is your friend. You should make an assessment each office visit. If you determine any service, covered or not, that you bill to Medicare may be denied today, you have the privilege of asking the patient to take financial responsibility by them signing an ABN today.
My Congressman's office called this morning.... Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.
It is my goal to help Chiropractors and their staff understand Chiropractic Medicare so they are successful with Medicare, keep out of trouble, provide the adjustments our Medicare patients NEED, and bill claims correctly so we, not only stay in Medicare, but so Chiropractic will be included in future governmental health plans.
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Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.
Remember....we all must become Medicare Compliant by the end of this year.