It’s that time of year again when I’m going through my email inbox and realizing there are more questions than I can humanly answer. First, thanks for your emails. Even if I can’t answer them all personally, they do provide the bulk of the material for my blog posts. After all, if 127 different docs all write in with a question on…XYZ…then I know it’s a point of confusion and one that needs some clarification.
Today's topic: Medicare ABN Over-use.
Somehow, somewhere down the line, chiropractors got the Medicare ABN confused.
And in our quest to be compliant, we hit our patients with ABN’s frequently. Perhaps a little too frequently. And it can cause patients to panic, to get irritated or perhaps leave your office altogether.
Here’s a few facts to help clarify the muddy waters:
- The ABN should not be used every visit for chiropractic adjustments. I have taken training calls with every Medicare carrier in the country and have heard this exact verbiage come out of all of their mouths. If you’re using the ABN every visit, you’re probably doing something wrong. Most commonly the error is made by the well-intentioned chiropractor who wants to cover their tail by issuing an ABN “just in case.” Sorry to be the bearer of bad news, but the ABN is not designed for that purpose. Medicare wants it black or white. In terms of the adjustment, either (a) you believe the service should be covered (Active Treatment) and therefore you don’t need an ABN or (b) you deem that the adjustment is for Maintenance and therefore is not going to be covered. Situation (b) requires an ABN.
- The ABN is not a blanket that covers any and all situations. Unfortunately, what most chiropractors want is a blanket form that will cover how Medicare will respond. In other words, if they deny the service, you want to be covered. If they pay, you’re good. There’s no form for that. On the contrary, the ABN is designed for you to inform your patient that you anticipate the service to be paid (based on the fact that you think it is medically necessary, active treatment) or that you expect that the adjustment will not be covered because it is for the purposes of maintenance. So, the burden and the purpose of the ABN is for YOU to decide – not for you to try and guess how Medicare will respond in the grey areas. As such, your ABN delivery should be more black and white. And if you keep it that simple, you will probably avoid the headaches in the process.
- The ABN is voluntary for all statutorily non-covered services. First let’s define statutorily non-covered services. These are services that Medicare never covers in any circumstances. Fortunately, this is simple: everything but your chiropractic spinal adjustment codes (98940,98941, 98942). So anything else: exams, x-rays, modalities, massage and yes, even your extremity adjustment (98943) are services that Medicare never covers. In these situations, issuing an ABN to inform your patient that Medicare won’t cover them is voluntary – yes, as in, not required.
Notice I am not saying not to use the ABN in these cases. I am saying that it’s up to you – voluntary. So, for some chiropractors who have panicked their patients by hitting them with excessive ABN’s – this may be a good choice.
I hope that clears up some of the misinformation out there. Certainly, some more questions may arise if you’ve been doing this incorrectly – but that’s another post for another day…
