Simplifying ABNs and Consent Forms: Practical Tips for Small Practices

Kim Darre, CPC, CPMA | Billing Manger

August 2, 2024

When asked to write an article for NAMAS, I wondered if I was qualified to do this. Then I remembered that I had been working in billing for small practices for over 14 years, and I felt pretty confident I could write this article. I will discuss the ABN (Advanced Beneficiary Notice) and other consents for the office setting. The main thing to know about the ABN is that only Medicare Beneficiaries need to sign one for services that the office knows will not be covered by Medicare.

According to CMS and Medicare Learning Network, you must issue an ABN:

When a Medicare item or service isn’t reasonable and necessary under Program standards, including care that’s:
Not indicated for the diagnosis, treatment of illness, injury, or to improve the functioning of a malformed body member.
Experimental and investigational or considered research only.
More than the number of services allowed in a specific period for that diagnosis.

For example, I work with a chiropractor, and Medicare does not cover an office visit or physical therapy when billed by a chiropractor. So, we must have our Medicare patients sign an ABN since we perform those services at each visit.

An ABN does need to be signed every year. In our office, we have established patients sign a new ABN at the beginning of each year.

An ABN does NOT need to be signed for Medicare Advantage plan patients.

The MLN also provides guidance if a patient doesn’t want to sign an ABN, “If the patient or their representative refuses to choose an option or sign the ABN, note the refusal on the original ABN. You can list refusal witnesses, but it’s not required. If a patient refuses to sign a properly issues ABN, consider not providing the item or service unless the consequences (health and safety of the patient or civil liability in case of harm) prevent it.”

Other insurance carriers might require a consent form to be filled out and signed if care is going to be administered and the insurance does not cover it. American Specialty Health is an example of this. They require a patient to complete a Member Billing Acknowledgment Form (MBAF). This acts like an ABN but for private insurance carriers. This informs the patient that they can be billed for services not covered by their insurance.

A good example of this would be massage (97124). Many insurance companies do not cover massage so it would be denied.

The best practice would be to have the ABN or other billing consent forms be a part of the new patient forms. That way, you don’t miss having the patient sign the correct forms. Our new patient packet has a specific form for patients to sign regarding non-covered services. It is also a good idea to check with your commercial carriers to see if they require any sort of form to be filled out by the patient for non-covered services. My motto is: when in doubt, fill it out!

About Ms. Darre:

Billing Manager for 14 years at a medical practice in Arizona and a NAMAS Member since 2012.

I have been a medical biller for over 14 years. I mostly work in chiropractic but have also worked in many different specialties, such as infectious disease, general practice, nutrition, and behavioral health.

NAMAS can help with questions and concerns about ABNs and other consent forms.