Monday, July 22, 2013
WASHINGTON, D.C., July 18, 2013—As Round 2 is rolling out, many providers have Medicare beneficiaries presenting at their doorsteps needing services that either do not want to seek out a contracted provider or would rather stay with a non-contract provider and pay cash for the needed items.
Non-contract providers can service patients in CBAs as long as each beneficiary signs an advanced beneficiary notification (ABN) that clearly indicates that Medicare will not pay for specified items because the beneficiary has chosen to obtain them from a non-contracted provider. The beneficiary then needs to choose an option to either have the claim filed with Medicare or to waive their Medicare rights. Such claims will be denied with a patient responsibility (PR) code, which allows a non-contracted provider to collect from a beneficiary.
Remember, if Medicare beneficiaries need service and choose to pay, you must obtain an ABN. There is an outdated reference on the CBIC website, currently under Round 1 information. Look for a link to updated information soon.
This guidance has been confirmed with Elaine Hensley, the chief liaison at the CBIC. If you have additional questions, contact AAHomecare’s Kim Brummett at 202-372-0750 or kimb@aahomecare.org. Also visit www.aahomecare.org.