Kathleen D. Schaum & Associates, Inc, Lake Worth, Florida, USA.
Adv Skin Wound Care. 2010 Mar;23(3):110-4. doi: 10.1097/01.ASW.0000363526.70383.c2.
If providers, physicians, practitioners, and suppliers have a genuine reason to expect that Medicare will deny their claim, they should give a CMS-R-131 ABN to the Medicare beneficiary. Valid signed and dated ABNs allow the provider to bill (and collect based on the provider's current charges) the Medicare beneficiary for the denied item or service. The Medicare allowable does not pertain in those instances. An invalid ABN or no ABN prevents the provider from billing the beneficiary, and the denied services must be "written off." Providers should create a list of procedures that commonly trigger Medicare denials. Educate the healthcare team to minimally provide the required ABNs. Do not issue CMS-R-131 ABNs to every Medicare beneficiary for every item or service provided. Remember, every Medicare beneficiary visit and every service does not warrant an ABN.
如果提供者、医生、医生和供应商有合理的理由预期医疗保险将拒绝他们的索赔，他们应该向医疗保险受益人提供 CMS-R-131 ABN。有效的已签署和注明日期的 ABN 允许提供者向医疗保险受益人收取（并根据提供者的现行收费收取）被拒绝的项目或服务的费用。在这些情况下，医疗保险可支付的费用不适用。无效的 ABN 或没有 ABN 会阻止提供者向受益人收费，并且必须“核销”被拒绝的服务。提供者应列出常见导致医疗保险拒绝的程序。教育医疗团队尽可能提供所需的 ABN。并非为提供的每项服务都向每位 Medicare 受益人提供 CMS-R-131 ABN。请记住，并非每次 Medicare 就诊和每次服务都需要 ABN。
