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Family Practice Coding Alert

Reader Question:

Refusal To Sign ABN

Question: Recently, a Medicare patient refused to sign the advance beneficiary notice (ABN) but insisted on receiving the procedure in question anyway. What can a practice do in a situation like this to make sure we are paid?

Montana Subscriber  
Answer: The practice should have a witness present to document that the patient refused to sign the waiver. The witness, who may be an employee of the practice, then signs and dates the waiver in place of the patient and makes a note indicating that he witnessed the refusal to sign. At this point, the service may be provided and the patient may be held responsible for the charges.
Many family practices misunderstand when a patient needs to sign an ABN. These waivers should be signed when the physician recommends a service or procedure that is covered by Medicare in some instances but might not be covered under current circumstances. This might occur, for instance, if a diagnosis does not support Medicare's standard of medical necessity for the procedure, or if a screening exam (e.g., screening mammography, 76092) is performed more frequently than Medicare allows.
ABNs are not necessary for services that are never covered by Medicare, like annual preventive exams. CMS recently revised the ABN form that practices should use with Medicare patients. Copies of the form are at
-- You Be The Coder and Reader Questions were reviewed by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; and Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians.