Advanced Beneficiary Notice Activity

CAHIIM:

IV.A.2 Evaluate the revenue cycle management processes

Your 75-year-old grandmother called and needs you to take her to the local hospital to have some tests run. The registration clerk tells your grandmother that she will need to sign an ABN notice because her Medicare policy might not pay for one of the tests that her physician has ordered. She is quick to sign the paperwork without asking any questions. The first thing that pops in your head is the $600 lab test that you just paid for because your insurance did not pay for because it wasn’t covered by your insurance. You know that your grandmother is on a fixed income and tight budget and would not be able to pay for such test without sacrificing something so you ask the clerk how much the test might be if not covered. The clerk just shakes her head and says that she doesn’t know and the facility makes her have every Medicare patient sign an ABN when they come in regardless of the tests being run. You grandmother is getting uneasy with all the questions and has you take her to have her tests run.

After the tests are run and you have dropped your grandmother back off at home, you go home and find more information online about ABNs.

Medicare Advance Beneficiary Notices

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf

ABN Form Instructions:

https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Form-Instructions.pdf

After reading through this information how would you respond:

1. If you were the clerk, explain how might you have handled this situation differently?

2. Recommend a better way of handling this situation that would inform the patient of specific information that may change from patient to patient.

3. Assess how this current process could have a positive or negative impact on the revenue cycle process of this facility.

4. Justify how your recommendations might improve the revenue cycle process for this organization.

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