Medicare Advance Beneficiary Notice (ABN) Compliance

The Medicare Advance Beneficiary Notice (ABN) is a critical compliance tool that informs patients when Medicare may not cover certain items or services. Misusing ABNs can result in audits, denied claims, and financial penalties. This live webinar, led by expert David J. Vaughn, ESQ., provides clear guidance on when and how to issue both mandatory and voluntary ABNs, ensuring your practice stays compliant and reduces financial risk.

Attendees will also learn how ABN strategies can apply to other payers with similar notice requirements, helping practices manage patient expectations, avoid unpaid claims, and protect their revenue cycle.

Learning Objectives

• Understand when issuing an ABN is mandatory versus voluntary

• Identify situations where ABNs should not be used

• Apply ABN modifiers correctly, including GA, GX, GY, and GZ

• Learn patients’ rights and responsibilities when completing an ABN

• Know how to handle situations where the ABN is not received

• Understand non-Medicare ABNs and when to use them

• Navigate common compliance pitfalls and minimize audit risk

Areas Covered in the Session

• What is an ABN and its purpose in compliance and billing

• CMS ABN source materials and recent updates

• Types of services requiring ABNs across hospitals, hospices, home health, SNFs, and physician offices

• ABN forms for different settings:

  • Physicians: CMS-R-131

  • SNFs: CMS-10055 (Part A) and ABN Part B forms

  • Hospitals: HINN series for inpatient stays

• How to properly fill out ABNs and handle patient signatures

• ABN scenarios including LCDs for anesthesia and new technologies

• Medicare Advantage and commercial payer considerations

• Handling refusals, coercion, and prohibited ABN uses

• Collecting and refunding patient payments

• Routine versus extended treatment ABNs

• Paper versus electronic ABNs

• Examples of courtesy ABNs and items Medicare never covers

• Practical compliance strategies to prevent denials and protect revenue

• Live Q&A session for real-world clarifications

Who Should Attend

• Physicians, Physician Assistants, Nurse Practitioners, and Nurses

• Office staff, practice managers, billing managers, and medical assistants

• Medical coders, auditors, and collection staff

• Compliance officers and CDI specialists

• Hospital revenue cycle staff and health information management personnel

• C-level executives and other personnel involved in Medicare payment processes