Question

If providers expect to treat a Medicare fee-for-service patient with a service or procedure that they anticipate being denied for reimbursement: A) Providers should proceed with the service and document it for future reference.

B) Providers should not perform the service unless the patient pays out-of-pocket.
C) Providers should contact Medicare in advance to discuss potential denial.
D) Providers should obtain an Advance Beneficiary Notice (ABN) from the patient.

Answer 1

Providers should obtain an Advance Beneficiary Notice (ABN) from the patient.

Step-by-step explanation:

If providers expect to treat a Medicare fee-for-service patient with a service or procedure that they anticipate being denied for reimbursement, the best course of action would be to obtain an Advance Beneficiary Notice (ABN) from the patient. An ABN is a form that communicates to the patient that Medicare may deny payment for the service, and if that happens, the patient will be responsible for the full cost. By obtaining an ABN, providers ensure that the patient is aware of the potential financial responsibility and can make an informed decision about whether to proceed with the service.

Option A, proceeding with the service and documenting it for future reference, may not be advisable because if Medicare denies reimbursement, the provider may not be able to recover the cost of the service. Option B, not performing the service unless the patient pays out-of-pocket, may not be a feasible option for many patients who rely on Medicare for coverage. Option C, contacting Medicare in advance to discuss potential denial, may be time-consuming and may not guarantee a favorable outcome.