Advanced Beneficiary Notices (ABNs)
If you have deemed that treatment is no longer medically necessary, then Clinicient recommends using an Advanced Beneficiary Notice (ABN). The process is similar to creating a letter as explained in Create, Print, and Fax Letters.
Note: If you want to use the standard ABN published by Medicare, then download the Medicare Standard ABN form.
Background
Effective January 2012, Medicare clarified that providers cannot ask patients to sign an Advanced Beneficiary Notice (ABN) just because the patient has reached the annual cap or MMR limits. The only time an ABN can be used is to transfer financial liability for treatment to the patient when the patient is notified that further treatment is no longer medically necessary, or a non-covered service is being provided. If the patient signs the ABN notification about non-medically necessary treatment, then the provider can bill Medicare with a GA modifier. The GA Modifier notifies Medicare that the patient has been notified and it is expected that the claim will be denied.
When to use an ABN
Patients should only be asked to sign an ABN if there is a reason to believe that Medicare will not pay for additional treatment because the treatment is no longer medically necessary; or because the treatment is a non-covered service.
For more information, refer to:
- Jerry Henderson's blog post: Medicare: It is About Medical Necessity
- Medicare ABN Noncoverage FAQ
Edit and print an ABN
Use the following steps to access, edit, and print the Access the ABN-Medicare Therapy Threshold with Excepted Diagnosis Letter.
- Log in to INSIGHT EMR.
- Open the Create a Letter window. Click
, which is located on the toolbar, or click Add on the Letters tab in the Client Editor. 
- In the Client list, locate and then click the patient whose case the letter refers to.
If you opened the window from the Letters tab, then the patient is already selected.
- In the Templates list, double-click the ABN - (Rev 3/11) template to open it.
- Click Print, then ask the patient to check the appropriate box and sign the letter.
- Click OK to save the letter in the patient's record and close the window.
You can file the ABN for future reference, or you can attach it into the system as part of the patients record.
Attach a signed ABN
Clinicient recommends that you scan the signed ABN outside of INSIGHT, then add it into the patient's electronic record as an attachment to the case. See Attach, Edit, and Print Documents for more information.
Once attached, you can view the letter on the Attachments tab. See View and Print Attachments for more information.
