Correction to Q&A

In last week’s Q&A on Meeting
Post-Delivery Obligations from health care attorney Jeff Baird
of Brown & Fortunato, the following is the correct answer to
the question “What happens when Medicare denies payment for
an item or service provided to the patient?“

A: A supplier that did not take assignment on a
claim that is denied by Medicare may hold the patient liable for
payment only if an ABN was properly issued and executed. A properly
issued and executed ABN is required to hold a patient liable for
claims denied by Medicare, regardless of whether the supplier
accepted assignment on the claim. If the supplier is a
participating supplier or otherwise accepted assignment on the
claim, then the supplier may not seek payment from the patient
(other than the applicable copayment or deductible) unless the
supplier gave the patient an ABN prior to furnishing the item or
service.

The supplier is required to submit assigned and non-assigned
claims for patients. That is, even if the supplier does not accept
assignment on the claim and gives the patient an ABN, the supplier
must submit the claim to Medicare for the patient, if the patient
requests that the supplier do so. However, there is no similar
requirement for the supplier to appeal denied claims for
patients.