The Advanced Beneficiary Notice (ABN)
Medicare requires that an Advanced Beneficiary Notice (ABN) be presented to patients when healthcare providers have reason to believe that a covered service may not be covered. The purpose of the ABN is to advise patients of their financial liability and present them with options.
Medicare informs patients that the only service that is covered when performed by a chiropractor is manual manipulation of the spine when medically necessary. Medicare goes on to state that they do not cover exams, x-rays, therapies, supplies and nutritional products.
Because medicare informs patients about what is – and what is not – covered in a chiropractors office, the ABN is not required to be administered on the first visit, unless that patient is going to start on maintenance care.
Medically necessity is defined by the government as treatment that attempts to improve and/or restore function. When an increase in function is no longer expected the ABN is required to be administered to a patient.
NOTE: Providers cannot charge for covered services that are maintenance unless the ABN has been properly administered. The signed ABN is good for one year.
Medicare patients will likely have several ABN’s in their file – one for each episode of care.