Tag: Advance Beneficiary Notice (ABN)
When in doubt, get out those ABNs
June 3, 2019Theresa Flaherty, Managing Editor
Have you ever been in Best Buy, simply trying to purchase whatever electronic device and been forced to listen to *The Spiel? It's been a few years for me, but I seem to recall it had to do with them trying to sell you some sort of warranty and now matter how politely or firmly you try to stop the cashier from wasting their breath (and your time), they are required by the Corporate Overlords to do it any way.
I was reminded of this recently while reporting a story about ongoing confusion regarding...
Reporter's notebook: Cash customer? ABN still gold standard
May 31, 2019Theresa Flaherty, Managing Editor
With more and more providers switching their focus from Medicare to cash sales, it's unsurprising that there's occasional confusion about whether an advance beneficiary notice is needed.
HME News recently received an email from a small DME supplier that has not billed Medicare in four years and recently learned they still needed to complete ABNs for all Medicare beneficiaries.
“We have people come into our business that have Medicare but are choosing to pay out of pocket because...
Billing reminders: RTLT modifiers, DWOs, ABNs
February 15, 2019HME News Staff
WATERLOO, Iowa - HCPCS codes that require the RTLT modifiers need to be on two separate claim lines effective for dates of service beginning March 1, VGM has alerted providers. Currently, it's acceptable to use one claim line with two units of service with RTLT�VGM has also reminded providers that they can complete detailed written orders for CPAP accessories, with the exception of the physician's signature and signature date. VGM says that DWOs are not required prior to delivery but are...
MACs ease denial process for oxygen claims
May 11, 2018HME News Staff
WASHINGTON - The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients.
“The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn't qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin.
Effective for claims with dates of service on or after Aug. 1, providers should...
Reporter's notebook: Loyal customers, the ABN and creativity
September 26, 2014Liz Beaulieu, Editor
Suppose you were an HME provider supplying a Medicare beneficiary with oxygen therapy through a competitive bidding contract. Suppose the beneficiary also needs non-prescription items like a hospital bed, mattress and other HME for which you don't have contracts.
Suppose the beneficiary and his or her children want to continue doing business with you, even though you don't have the contracts. What are your options?
“You can't sell the equipment to the patient, so we sell the...
Reporter's notebook: Loyal customers, the ABN and creativity
September 12, 2014Liz Beaulieu, Editor
YARMOUTH, Maine - Suppose you were an HME provider supplying a Medicare beneficiary with oxygen therapy through a competitive bidding contract. Suppose the beneficiary also needs non-prescription items like a hospital bed, mattress and other HME for which you don't have contracts.
Suppose the beneficiary and his or her children want to continue doing business with you, even though you don't have the contracts. What are your options?
“You can't sell the equipment to the patient,...
Take PECOS seriously, stakeholders say
November 8, 2013Liz Beaulieu, Editor
WASHINGTON - CMS has set a new start date for denying DME claims with the names of physicians who are not enrolled in PECOS and, this time, it may stick, industry stakeholders say.
Starting on Jan. 6, 2014, claims with the names of physicians who are not enrolled in PECOS will be denied, and the provider who submitted the claims will not be paid for the items or services that were furnished. Most recently, CMS had planned to start denying claims on May 1, 2013.
“It feels real this time,”...
Cash + ABN can keep non-contract suppliers in the game
July 17, 2013HME News Staff
BALTIMORE - Non-contract suppliers in Round 2 competitive bidding areas can provide service to Medicare beneficiaries if the patient agrees to pay cash and signs an advanced beneficiary notice (ABN), AAHomecare advised in a bulletin this week.The ABN must clearly state that Medicare will not pay for specified items because the beneficiary has chosen to obtain them from a non-contracted provider.The beneficiary then must choose whether to file the claim with Medicare or waive their Medicare rights....
Filling the void left by The Scooter Store
May 10, 2013Elizabeth Deprey
NEW BRAUNFELS, Texas - When The Scooter Store, the industry's largest provider of power mobility devices, is wounded, what does it mean for those providers left standing?
So far, it has meant more Scooter Store customers seeking them out for repairs. Since a layoff this spring that reduced staff at the company to 300 employees, customers are having trouble reaching a live person—so much so that the provider posted a do-it-yourself repair FAQ on its website in April.
“We've...
Have ABNs become 'gray area'?
April 5, 2013Elizabeth Deprey
WASHINGTON - The proper use of advance beneficiary notices (ABNs) has shifted—and not in the HME provider's favor, industry stakeholders say.
CMS has evolved its policy to the point where providers can no longer use ABNs to “upgrade” within the same code, says Andrea Stark, a reimbursement consultant with MiraVista.
“We are operating in gray areas,” she said. “It has definitely been an erosion of how we utilize this.”
Case in point: In January,...