Coding
Respond
A Medicare patient presented to the hospital for a minor outpatient surgical
procedure (that was not cosmetic in nature). The procedure is not considered
medically necessary by Medicare for patients with the presenting diagnosis. No ABN
was presented to the patient before the outpatient surgery. When the patient was
being discharged from the recovery room after the outpatient procedure involving
anesthesia had been completed, an ABN was presented to the patient because the
procedure was not medically necessary. The patient signed the ABN without
objection and the hospital billed Medicare for the procedure. Medicare denied the
claim on medical necessity grounds. Please discuss:
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Whether the ABN was valid
Whether the hospital should seek payment from the patient for the
services it provided if Medicare does not pay, including the reasons why or
why not.
What steps a hospital should take to avoid a similar occurrence in the
future.
For purposes of this discussion, please focus on whether the ABN form was
appropriately given and not whether the services were medically necessary, covered
or indicated.
For your reply post, select one classmate that you agree or disagree with, and add
additional support to their rationale, constructive critiques, or ask a question to
further elaborate their position. Use references from the course readings and
lectures to support your rationale.
Respond Discussion Guidelines:
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Your initial posts should be posted by Thursday at Midnight CT.
Posting length should be 1-2 paragraphs.
You should follow up with a minimum of one substantive response to a classmate by Sunday at
Midnight CT.
Click on the vertical three dots (icon in the upper right corner) of this text area for more information
on how you will be evaluated.
Most discussions have TWO deadlines: the first is the due date that you should post your INITIAL
reply to the topic, and the second is the date by which you should post the required number of
FOLLOW-UP postings.
Utilize the Standard Written Rubric
NOTE: Only the second date will appear on your course calendar, so set a reminder for yourself for the INITIAL
posting date each unit.
React
Under the Medicare limitation on liability, a Medicare beneficiary cannot be held
liable (or charged) for non-covered services if the beneficiary did not have advance
notice that the services would not be covered by Medicare.
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Discuss and contrast the two advance notices from this Unit that limit the
beneficiary’s liability.
Describe when each should be provided and the effect of not timely
providing the notice.
Include an analysis of patients' rights in these situations.
Assignment specifications:
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Submission should be 1-2 pages in length, not including title page and
reference list
Submission should include appropriately cited references from both course
materials (and external sources if necessary) both in-text and in a
reference list.
Submit your assignment by Midnight CT on Sunday of this Unit.