Friday, October 7, 2011

Effective usage of ABN notice

HOW TO EFFECTIVELY DELIVER AN ABN

ABN delivery is considered to be effective when the notice is:

  •      Delivered and comprehended by a suitable recipient. 
  •      The correct ABN approved notice with all required blanks completed.

Note: Failure to use the correct notice may lead to providers being found liable.

  •      Delivered to the beneficiary in person if possible.
  •      Provided far enough in advance of potentially non-covered items or services to allow sufficient time for the beneficiary to consider all available options.
  •      Explained in its entirety and all beneficiary-related questions are answered.
  •      Signed by the beneficiary or his representative.



Options for Delivery Other Than In-Person

In circumstances when in-person delivery is not possible, an ABN may be delivered through the following means:

  •      Telephone.
  •      Mail.
  •      Secure fax machine.
  •      Internet e-mail.

When delivery is not in-person, the contact must be documented in the patient’s records. To be considered effective, the beneficiary cannot dispute such contact. Telephone contacts must be followed immediately by either a hand-delivered, mailed, e-mailed or faxed notice. The beneficiary or representative must sign and retain the notice and send a copy of this signed notice to the provider for the retention in the patient’s record.

The provider must keep a copy of the unsigned notice on file while awaiting receipt of the signed notice. If the beneficiary does not return a signed copy, the provider must document the initial contact and subsequent attempts to obtain a signature in appropriate records or on the notice itself.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download