Ambulance ABN (Advanced Beneficiary Notice)

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Ambulance ABN (Advance Beneficiary Notice)

 

Ambulance ABN Discussion

The Advanced Beneficiary Notice (“ABN”) is a Medicare form designed to give patients an estimate of charges for non-covered services. The form should only be used for stable, non-emergency patients. To be valid, the form must be filled out completely by the provider then given to the patient to read and sign. The provider should make sure the patient can see and read the form. The form must be fully filled out. Do not leave fields blank if they apply to the situation at hand.

Non-covered services can be excessive mileage beyond the local area, transports to physician’s offices and even repetitive transports that exceed the approved quantity of transports. When in doubt, use an ABN, but do not use them in place of patient billing authorizations and do not use them for unstable or emergency patients. ABNs are for non-emergency situations where the patient is requesting a service that is not reasonable and necessary.

CMS provides the following examples to demonstrate when an ABN is required:

Example: A beneficiary requires ambulance transportation from her SNF to dialysis but insists on being transported to a new dialysis center 10 miles beyond the nearest dialysis facility.

Medicare covers this type of transport; however, since this particular transport is not to the nearest facility, it is not considered a covered Medicare benefit. Therefore, NO ABN is required. As a courtesy to the beneficiary, an ABN could be issued as a voluntary notice alerting her to the financial responsibility.

Example: A beneficiary requires non-emergent ground transport from a local hospital to the nearest tertiary hospital facility; however, his family wants him taken by air ambulance.

The ambulance service is a covered benefit, but the level of service (air transport) is not reasonable and necessary for this patient’s condition. Therefore, an ABN MUST be issued prior to providing the service in order for the provider to shift liability to the beneficiary. An ABN is mandatory only when a patient’s covered ambulance transport is modified to a level that is not medically reasonable and necessary and will incur additional costs.

Repetitive Non-emergency Patients

The repetitive patient could easily require an ABN.  These patient’s transport services could become non-covered quickly.  Prior authorization approvals are for limited numbers of transports and limited time frames.  Patients do get written notices from their local Medicare carrier, but these notices are hard to read and may not arrive on time.  Patient confusion over when a transport is covered is quite believable.  This is exactly the type of situation the ABN was designed for.  Providers should stay vigilant to track their approvals, patient need to be advised before transport when an approval has not been issued and a denial is possible.  Failure to obtain an ABN could trigger the provider’s own liability for the charges and interfere with billing efforts later in the case.

Conclusion

If a specific type of ambulance transport is statutorily excluded from coverage because it fails to meet Medicare’s definition of the ambulance benefit, a voluntary ABN can still be issued by the provider to notify the beneficiary of his/her financial liability.  In this case the ABN is not required, it is just a courtesy to the patient.  However, if the patient could have been confused about Medicare’s coverage, Medicare may side with your patient if they argue they had no way of knowing.  Call it a courtesy if you want, we think it is a good idea to use an ABN when dealing with any potentially non-covered ambulance transport.

When an ambulance provider does issue an ABN, they must be sure to follow all rules and complete it correctly.  ABNs incorrectly completed will not be considered valid.  The form must be completed and given to the patient to sign prior to providing the service.  You must keep the original ABN in the patient file and provide a copy to the patient.  Be sure the patient can see the ABN too.  If requested, you must provide a copy to your Medicare Administrative Contractor (MAC).  The ABN should be attached to the patient chart like any other billing form, refusal or PCS.

 

Ambulance ABN Resources

Collecting From Medicare Patients – Palmetto GBA…Click Here

Land Ambulance – Non Covered Transports – Palmetto GBA…Click Here

Sample ABN form from Page Wolfberg & Wirth…Click Here

CMS Article on use of an ABN form…Click Here

 

We hope you have benefited from our discussion of the Ambulance ABN.

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