Podiatry practices deal with a lot of issues in treating their patients. Among them, ABN requirements in podiatry billing are the most complicated ones. ABN is used as a standard process for informing patients about the out-of-pocket costs. Taking this step not only helps in clarification about costs but also makes the entire billing process transparent.
In this blog, we will discover when ABN is required in podiatry procedures and how to apply the ABN modifiers in podiatry billing. Besides understanding the ABN requirements, this guide will help you minimize the podiatry insurance claim denials and deliver the results you desire the most.
The ABN Puzzle in Podiatry
An Advance Beneficiary Notice of Noncoverage (ABN) is a written document. It outlines the important details, like transferring the costs of the procedure from the insurance company to the patient. Many procedures are not covered under podiatry medical billing rules, such as:
- Cutting or removal of corns and calluses
- Trimming, cutting, clipping, or debriding of nails
- Hygienic and preventive maintenance care
Foot care surgeons and physicians are required by law to issue ABNs when they expect the rendered medical care services will not be reimbursed by the payers. This document clearly delegates the financial responsibility to patients if Medicare refuses to pay providers. In this case, patients must pay the partial or full payments to their podiatrist for rendered services. This way, healthcare providers help minimize claim denials and financial losses.
When Is an ABN Required in Podiatry?
A provider may ask the patient to sign an ABN when they think there is a fair chance that Medicare won’t accept the medical claim. This is typical in podiatry documentation requirements before proceeding to perform the procedure. Podiatry practices require this documentation because it is likely that, in Medicare’s view, the procedure is either not medically necessary or considered routine foot care.
Preventive foot care services are often tied to ABN because they are not part of the treatment for ongoing illness or injury. Cosmetic surgeries and treatments also require providers to obtain their patients’ signatures on the ABN form because they are not covered by the Medicare health plan.
It is utmost important for podiatrists to inform their patients about the out-of-pocket costs related to the procedure and post-operative charges. In case providers are unable to inform patients, the claim will be denied, resulting in bad debt or write-off. The failure to inform may also result in a lawsuit against the practice, which could lead to compliance audits and penalties.
The Cost of Getting It Wrong
On the one hand, the advance beneficiary notice of noncoverage (ABN) improves the communication between the provider and the patient. On the other hand, failure to do so results in increased challenges to podiatry reimbursement. Let’s discuss some of the challenges your practice may face if a failure does occur, and how you can mitigate the impacts of it. The consequences of failing to issue an ABN are:
Claim Denials
Failure to comply with Medicare ABN podiatry guidelines and not informing patients on time results in claim denials. Insurance companies almost always deny claims that are not supported by medical necessity documentation.
Lost Revenue
Timely podiatry patient communication ABN transfers the financial cost to patients. If your billing team is unable to do so, providers must absorb the financial responsibility, resulting in lost revenue.
Administrative Burden
Administrative burden is increased by not following podiatry billing compliance ABN. Medical practices have to spend extra resources and time to rework claims, filing appeals to recover the procedure amount from payers.
Regulatory Noncompliance
ABN is an essential regulatory requirement set by Medicare when there is even a slight chance that any procedure will not be covered by the insurance. Overlooking these results in audits for podiatry coding and compliance in billing.
Unexpected Bills
Not providing an ABN to patients results in unexpected billing to patients, who may refuse to pay for the procedure. This leads to trust damage between the patient and providers.
Decision-Making Limitations
Not following the ABN process limits the decision-making for providers. There’s a chance a patient may decline to proceed with the procedure, adding financial burden on podiatry practices due to non-payment.
How to Use ABNs Effectively
To minimize podiatry billing denials and ABN-related issues, foot care surgeons can use the following strategy:
Routine Foot Care
Routine foot care claims are often denied by Medicare. A podiatry physician should acquire prior authorization from insurers, and the billing team can identify which procedures are covered and not covered under the health plan.
Orthotics & Footwear
Orthotics and DME medical devices like diabetic shoe inserts and braces have strict meeting criteria. Obtain ABNs from patients that will help in delegating financial responsibility to patients and allow transparent communication before the procedure.
Frequency Limits
Podiatry billers can read and understand the frequency limit imposed by Medicare and commercial payers. If a procedure is performed too often, it is likely to be rejected by payers, leading to increased financial loss.
Experimental/Non-standard Treatments
Medical professionals should avoid providing novel or experimental treatments to patients. Any treatment option that’s not classified as standard and medically necessary will be denied by the insurance company.
Be Specific in Use of Language
Always be specific and use plain language free of jargon so patients can clearly understand the procedure requirements and its cost estimate. Allow patients to decide whether they will move forward and take full financial responsibility if the claim is denied, or decline it.
Patient Communication: Turning Compliance Into Trust
Providers and podiatry practices can develop many strategies for making ABN discussions part of a positive patient experience by doing:
Jargon-proof Explanation
The Podiatry RCM team can make the entire process of obtaining ABNs from patients as seamless as possible. A clear, jargon-proof communication enhances the cooperation from the patient side, leading to better outcomes. Medical billers can obtain the aggregate billing amount from Medicare for the procedure and inform patients so they don’t get price shock. Additionally, simple explanations help patients understand their financial responsibility in case insurance refuses to entertain the claim.
ABN Discussions
Foot care clinics can arrange ABN discussions regularly to educate patients on Medicare reimbursement requirements. This step will improve the effectiveness of such strategies and foster positive patient experience and trust. Providers can also list procedures requiring ABNs for patients and help them understand the financial responsibility if they proceed with the procedure.
Best Practices for Podiatry Billing Teams
Staff Training
For seamless workflow in podiatry billing, providers can arrange orientation training for new medical billers. Moreover, on-the-job training and refresher courses can also play a big role in optimizing compliance with Medicare reimbursement rules.
AI-Integrated Billing Software
Podiatry physicians can opt for medical billing software equipped with AI for prompt ABN notifications before the procedure. This step will notify the billing team to obtain a signed consent from patients for financial responsibility in case of reimbursement refusal.
Create an ABN Checklist
The podiatry billing services team can create a checklist to ensure all essential steps before the procedure have been taken. Creating a checklist helps standardize all processes where ABNs are mandatory for error-free medical claims. Following this checklist helps medical billers identify if they have missed any key steps that may result in underpayments or denials.
Key Takeaway
Obtaining ABNs is more than just formal paperwork. It plays an integral role in your practice’s transparency in communication with the patients. Overlooking its importance results in a complete financial burden falling on the provider’s practice. Podiatry clinics and healthcare facilities can take many steps, like training their in-house staff, creating a checklist before patient intake, which results in the prevention of denials.
Though obtaining ABN from patients is not easy, as it requires transparent communication with patients. Outsourcing trained staff in procedures of obtaining ABNs from patients helps practices in tackling this challenge. Medheave has a skilled team of podiatry coders and billers who rigorously follow payer rules so you can receive cash flow consistently without disruption. Our medical billing obtains advance beneficiary notice of non-coverage (ABN) from patients, so you get paid for procedures and medical care without unfair deductions.
FAQs
What is an ABN in medical billing?
An advance beneficiary notice for non-coverage is a formal consent document entailing details of financial responsibility. In procedures where Medicare or commercial payers refuse to pay, providers are required by payers to delegate the financial responsibility to patients. When the patients sign this after consultation with providers, they take full responsibility to pay all the costs about the medical services rendered by a medical professional.
For which procedures in podiatry, Medicare require an ABN?
The following procedures require advance beneficiary notice for non-coverage:
- Trimming, cutting, clipping, or debriding nails (including mycotic nails if not medically necessary).
- Cutting or removal of corns and calluses.
- Routine hygienic and preventive maintenance care, such as:
- Cleaning and soaking feet
- Application of skin creams for skin tone
- Other non‑medical foot care services
When must podiatrists issue an ABN?
Podiatrists and foot care hospitals must issue an ABN when it is required and explicitly conveyed by the payers. Additionally, whenever a podiatrist feels that there’s a chance their reimbursement claim may be denied due to routine foot care that’s been performed frequently. Only in certain cases, like ER, or at-risk diabetic patients who require immediate medical intervention in cases like gangrene, frostbite, and life-saving amputation or surgery, may over-ride such necessities.
