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Is anyone familiar with or use Medicare ABNs? I am trying to determine if that is something our agency needs to be utilizing.
We currently only bill Medicare Part B for our Immunization Clinic which only covers flu and pneumonia.
If we have a Medicare Client that would like another vaccine we inform them that Medicare Part B does not cover that and sometimes their prescription plan will cover it but they would need to contact an in-network pharmacy.
If the Client insists on getting the vaccine at our Health Department we can offer them our self pay rate. If that is the case would that client need to fill out a Medicare ABN?
I appreciate any help on this topic!
You only need to obtain an ABN if the service being provided is a service that is customarily covered by the Medicare plan and you are having the client pay for this service because for whatever reason it is likely to be denied.
Example ( I know this is unlikely but for example purposed only) ….client requests a flu imms in January but had already received this service in Novemeber, then the client would have to self pay the imms cost as Medicare will only cover one vaccine per season. In this case, the client would need to sign the ABN.
If a client with Medicare B requests a Tdap and chooses to self pay, since this is not covered by Medicare Part B, then no ABN is needed.
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