Eye-care technicians are invaluable in supporting a practice’s compliance efforts and the patient experience. Both aspects come into play with the Medicare Advance Beneficiary Notice (ABN), which notifies patients, in advance, of the cost of services that may become their financial responsibility. Practices are required to use the ABN form for their Medicare Part B fee-for-service patients when applicable. (Medicare Advantage and other payers outline their own advance notice procedures.)

While the ABN has long been available to Medicare patients, providing financial transparency to all patients has become a hot-button issue — and for good reason. At times, patients have suffered greatly from the lack of opportunity to express their financial hardship or to make an educated choice prior to incurring an expensive, nonemergent medical treatment. Today’s patients are informed consumers; practices and their personnel must provide transparency to remain competitive.

Issuing the ABN form when it applies is a clinical skill. Below are 5 tips for successful implementation.

1. Use the correct ABN version.

The current ABN form (along with instructions) is available at the CMS website (tinyurl.com/Compliance521 ). ABN re-approval occurs every 3 years, making it critical to use the most updated form. Use of outdated versions is considered noncompliance. While you are permitted to customize an ABN, it is not advised, as all form language, fonts, contrast, etc., are required.

2. Identify when an ABN applies.

In certain situations, technicians and surgery coordinators can help patients understand their financial responsibility or the potential for their financial responsibility. Those include:

• When physicians plan to use new technology diagnostics tests, for which Medicare may have restrictive coverage indications.
• When ophthalmic procedures may be construed as cosmetic by Medicare and be noncovered due to strict indications.
• When procedures with cosmetic intent are performed.

3. Train on best practices for patient education.

Write a protocol for ABN use and provide training for all clinic members. This ensures that everyone is clear on the use of ABNs, when they apply, and how to explain their purpose to patients. Also, consider roleplaying so that technicians are comfortable having these conversations with patients at the right time. Properly educating patients on their potential financial liability is a great service and reduces any monetary surprises.

4. Set up the clinic for efficiency.

For diagnostic tests and procedures where coverage is in doubt, create folders of partially completed ABNs with a list of your Medicare Administrative Contractor’s covered diagnoses. These folders should be located next to diagnostic equipment and on the surgery coordinator’s desk. By having ABNs ready, partially completed with common reasons for noncoverage and fee estimates, efficient conversations can take place with patients to obtain their signatures prior to test or procedure performance.

5. Follow through with billing modifiers.

When an ABN is signed before a service or procedure is provided, certain modifiers are required by Medicare to ensure the payer is informed of the ABN’s execution; most often GA is used:

• GA (liability waiver issued)
• GX (voluntary liability notice)
• GY (service statutorily excluded; combine with GX when appropriate)
• GZ (service not reasonable/necessary and no ABN executed)

These modifiers identify why the ABN was used and should be added to the service’s CPT code before billing, whether that is done in the exam room or by the billing team.

Success!

Getting organized to efficiently ensure your patients do not experience financial surprises pays off big in the patient experience, and most importantly, in receiving reimbursement for services provided. OP