ABN and eye clinic

We have an Eye Clinic and I recently learned that they are having MC patients sign an ABN prior to being seen in the exam room. best way to handle it?rationale for this is that the provider has no idea what if anything will be needed until the exam is completed. They say for them to stop the exam pull the patient out of the room and go over the specifics in problematic.

I am concerned as they are possibly blanketing and this is problematic.

Was wondering if you had any wisdom on this subject and possibly the best way to handle it. Thank you for your assistance.

re: ABN and eye clinic

If you are having the beneficiary sign the ABN for the refraction (92015), it is not necessary because refraction is never a Medicare covered service. This is by law and therefore no ABN is necessary. If you are requiring the ABN for the rest of the exam which Medicare may cover under some circumstances, you could establish the need for an ABN by questioning the patient about their reason for requesting the exam. If they say it is just a routine exam, you could have these patients sign an ABN stating that routine care is not considered medically necessary and therefore may not be covered by Medicare. If they have a medical complaint, the exam should be covered.

re: ABN and eye clinic

This is blanketing, and you are correct - it is problematic! Blanket ABNs are a BIG no-no! ABNs have to be service specific, diagnosis specific, and date specific. I bill for 6 ophthalmologists (each in a different subspecialty) and they each have to use ABNs in their own unique ways. If a service is about to be performed that has an LCD & is going to be billed with a non-covered diagnosis, the techs take a moment to explain to the patient why the testing service needs to be performed & that Medicare will not cover it for their particular diagnosis. It's at this time that the patient can decide if they want the service performed KNOWING that they will be financially responsible for said service. Keep in mind that ABNs are a type of 'informed consent', and the ABN provides the knowledge for them to determine whether or not they want to accept the financial responsibility of a non-covered service or item. ABNs aren't required for refractions since they are statutorily excluded, but we have the patients sign one anyway, again as a type of 'informed consent' - most patients don't know that there are many services that are statutorily excluded from Medicare coverage so it's our way of relaying that information to them.

re: ABN and eye clinic

Codes 99172,99173 and 99174 are for visual function screening, visual acuity
screening and automated refraction and Medicare does not reimburse for any
of these three. I have never known of an Ophthalmology practice that did not
charge for these, either with or without an ABN. If you are do not sign an ABN
and if you do sign an ABN, you will receive a bill. They do know what will not
be paid. A general ABN is no good, ABNs are supposed to be specific.
I believe that practices are not supposed to bill for procedures that they
know are not covered . Someone else may know more about that part of
it than I do.

re: ABN and eye clinic

that is the purpose of the ABN: to inform patients of non-covered items and/or services, and be able to receive financial compensation from the patient (instead of Medicare) for those things Medicare does not cover. With the 3 codes you just mentioned, per CPT®, "these services may NOT be used in addition to general ophthalmological services or E&M services" - therefore an ABN would be inappropriate. (A similar scenario would be Medicare doesn't cover surgical trays separately - they consider it to be integral to the surgery; therefore, you cannot have the patient sign an ABN & ask for monetary compensation from the patient for a surgical tray. The same goes for any item or service that Medicare deems to be 'bundled' into another item or service.)