Q/A: What do I do When a Medicare Patient Refuses to Sign an ABN?

April 8th, 2019 - Wyn Staheli, Director of Research
Categories:   Medicare  

Question: What do I do when a Medicare patient refuses to sign an ABN?

Answer: That depends on whether the patient is still demanding to have/receive the service/supply. If they aren’t demanding the service, then there is no need to force the issue. Just make sure that you still have an ABN with a note on it which states the patient refused to sign it.

However, if they are demanding the service, then even though the Medicare Claims Processing Manual, Chapter 30, Section 40.3.4.6, states that “The beneficiary cannot properly refuse to sign the ABN at all and still demand the item or service” there are a few exceptions to that statement.

The following additional information from CMS provides some guidance:

If the beneficiary or the beneficiary’s representative refuses to choose an option or sign the notice, you should annotate the original copy indicating the refusal to choose an option or sign the notice. You may list any witnesses to the refusal, although a witness is not required. If a beneficiary refuses to sign a properly issued notice, consider not furnishing the item or service unless the consequences (health and safety of the beneficiary or civil liability in case of harm) prevent this option.

So the above applies whether the patient is refusing to choose an option or just refusing to sign the ABN. Now, if they do choose an option and just refuse to sign the ABN, you have to decide if you are going to really furnish the service/supply. Technically, you could, but since chiropractic care generally is not considered essential to their health/safety it’s not going to be paid by anyone, including the patient. Therefore, it’s best to not provide the service.

One other ‘refusal’ situation that has arisen that causes some problems occurs when a patient has signed an ABN and then they change their mind. If that is the case, don’t complete another ABN. It’s better to have them mark their revision on the original ABN along with a date and signature.

Bottom line: If they are refusing to sign the ABN, note that refusal on the ABN (yes, you still need one) and just don’t provide the service since you aren’t going to get paid for it.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association