A Medicare patient at a primary-care office requests another covered preventive service that already exceeds Medicare’s allowed frequency for the period. Denial for frequency is expected. When should the practice consider an ABN?
Select an answer to reveal the explanation.
Short Explanation
Frequency limits are one of those “Medicare might say no” moments where an ABN actually fits. If the preventive visit is about to blow past the allowed count, get a completed ABN in the patient’s hands before you do the service. Waiting until after the denial is too late for the notice to do its job.
Full Explanation
When Medicare is expected to deny a normally covered service because frequency limitations have been exceeded, an ABN may be appropriate so the beneficiary understands potential financial liability before the service is furnished. The ABN should identify the specific service and the reason Medicare may not pay. Issuing no notice, using a blank form, or waiting until after denial does not meet ABN timing and content expectations for physician-office billing.