Advance Beneficiary Notices: Provider Responsibilities and Resources
Maintaining strict compliance with Medicare’s Advance Beneficiary Notice (ABN) requirements is essential across both Ambulatory and Acute care settings. As ABN utilization increases in our hospitals and clinics, it is critical that physicians understand when an ABN must be issued, how Epic supports the workflow, and what regulatory standards are required from providers at every step. The Epic ABN workflow reinforces the compliance expectations for providers in both care environments and highlights the shared responsibilities that protect our patients, our organization, and our billing integrity.
Provider Responsibilities
Address the ABN warning to improve patient experience.
Do NOT ignore an ABN warning before signing an order. By addressing the initial ABN warning, you are able to explore alternative diagnoses that are covered by Medicare or begin facilitating conversations with patients regarding non-coverage.
Educate your patients.
Begin to educate your patients as soon as possible once an ABN is triggered. Explain what an ABN is, how this could affect the services they receive, and their options as patients. Clinician education at the point of ABN trigger decreases the likelihood of front desk staff having to contact the provider about the ABN after the visit.
Clarify medical necessity.
Address questions or concerns regarding the medical necessity of the service in question so patients can holistically decide if they want to accept the financial responsibility to receive the procedure. Patient satisfaction could be adversely affected if patients do not understand the financial implications of ABNs
Clearly outline patient options.
Leverage scripting and clinical expertise to explain why a particular service might not be covered by Medicare, including medical necessity and alternatives. Clearly outlining all applicable patient options will enhance patient understanding.
Resources
Questions?