Overview:

The Medicare Advance Beneficiary Notice (ABN) is a critical document that providers must present to patients when they anticipate Medicare will deny payment for specific items or services. Navigating the rules for ABNs can be complex, with distinctions between mandatory and voluntary usage that are essential to understand. Errors in form submission or procedural mistakes can trigger audits and significant financial penalties.

This live webinar, led by expert David J. Vaughn, ESQ., will provide clear, actionable guidance on how and when to use both mandatory and voluntary ABN forms in a fully compliant manner. The compliance principles discussed are also highly applicable to similar forms required by many other payers, making this knowledge broadly valuable. Fundamentally, the ABN acts as a liability waiver, empowering patients to make informed decisions about their care while protecting your practice from unpaid claims and compliance risks.

Learning Objectives:

• Distinguish between situations where an ABN must be used, may be used as a courtesy, or should not be used.

• Correctly apply ABN modifiers (GA, GX, GY, GZ) to claims.

• Understand patient rights and provider responsibilities during the ABN process.

• Identify the financial implications for both parties if an ABN is not obtained.

• Navigate the use of Non-Medicare ABNs for commercial payers.

Areas Covered in the Session:

• Fundamentals: What is an ABN and where to find official CMS resources.

• Application: Determining which services require an ABN across different settings (Hospitals, Hospices, Physician offices, SNFs, Home Health) for both Part A and Part B.

• Form Management: Selecting the correct form (CMS-R-131, CMS-10055, HINN notices) and completing it accurately.

• Practical Scenarios: Real-world examples of ABN use, including cases involving Local Coverage Determinations (LCDs) and new technologies.

• Advanced Topics: Handling Medicare Advantage plans, commercial payers, patient refusals to sign, and the specific rules for Qualified Medicare Beneficiaries (QMBs).

• Compliance & Operations: Prohibited uses, retention requirements, collecting payments, handling electronic ABNs, and managing extended treatment scenarios.

• Live Q&A: Get your specific questions answered by an expert.

Who Should Attend:

This webinar is essential for all professionals involved in the revenue cycle and compliance processes, including:

• C-Level Executives, Practice Managers, and Office Managers

• Physicians, Nurse Practitioners, Physician Assistants, and Nurses

• Billing Managers, Medical Billers, Coders, and Auditors

• Hospital Revenue Cycle Staff and Patient Accounts Personnel

• Compliance Officers and Health Information Management (HIM) staff

• Collection Staff and CDI Specialists

• Any personnel involved in the Medicare payment system.