APMA News - July/August 2020 - 37
Reimbursement
* Any experimental items and services
* Items and services with frequency coverage limitations
* Medical equipment and supplies denied because the supplier had no supplier number
* Services always denied for medical necessity
The simplest way to think of this list is that providers do
not need to provide an ABN for anything that is generally
covered, but only for those items that, at times, may be considered not covered or not medically necessary. Prohibitions
include that providers cannot issue an advance written notice
of noncoverage due to a Medically Unlikely Edit (MUE) or if
a beneficiary is in a medical emergency or under great duress,
which may appear to be a coercive circumstance. It goes
without saying that the ABN should not be used to transfer
liability to the beneficiary when Medicare would otherwise
pay for items and services.
When Not to Use an Advance Written Notice of Noncoverage
Providers must not use an advance written notice of noncoverage for items and services they furnish when the patient
is in a Medicare Advantage plan (Part C) or the Medicare Prescription Drug Benefit (Part D). If the patient has an insurance plan other than Medicare, providers may want to check
with the different insurance plans they participate with to see
if the plans have their own ABN. TRICARE, for example, has
its own ABN that providers must use when they need to inform beneficiaries regarding non-covered items. To obtain a
copy, visit www.tricare-west.com/content/dam/hnfs/tw/prov/
auths/pdf/request-noncovered.pdf. n
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APMA News July/August 2020
37
http://www.tricare-west.com/content/dam/hnfs/tw/prov/auths/pdf/request-noncovered.pdf
http://www.tricare-west.com/content/dam/hnfs/tw/prov/auths/pdf/request-noncovered.pdf
http://apma.officialbuyersguide.net
APMA News - July/August 2020
Table of Contents for the Digital Edition of APMA News - July/August 2020
Contents
APMA News - July/August 2020 - Cover1
APMA News - July/August 2020 - Cover2
APMA News - July/August 2020 - 3
APMA News - July/August 2020 - 4
APMA News - July/August 2020 - 5
APMA News - July/August 2020 - 6
APMA News - July/August 2020 - 7
APMA News - July/August 2020 - Contents
APMA News - July/August 2020 - 9
APMA News - July/August 2020 - 10
APMA News - July/August 2020 - 11
APMA News - July/August 2020 - 12
APMA News - July/August 2020 - 13
APMA News - July/August 2020 - 14
APMA News - July/August 2020 - 15
APMA News - July/August 2020 - 16
APMA News - July/August 2020 - 17
APMA News - July/August 2020 - 18
APMA News - July/August 2020 - 19
APMA News - July/August 2020 - 20
APMA News - July/August 2020 - 21
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APMA News - July/August 2020 - 23
APMA News - July/August 2020 - 24
APMA News - July/August 2020 - 25
APMA News - July/August 2020 - 26
APMA News - July/August 2020 - 27
APMA News - July/August 2020 - 28
APMA News - July/August 2020 - 29
APMA News - July/August 2020 - 30
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APMA News - July/August 2020 - 34
APMA News - July/August 2020 - 35
APMA News - July/August 2020 - 36
APMA News - July/August 2020 - 37
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APMA News - July/August 2020 - 60
APMA News - July/August 2020 - 61
APMA News - July/August 2020 - 62
APMA News - July/August 2020 - Cover3
APMA News - July/August 2020 - Cover4
APMA News - July/August 2020 - A1
APMA News - July/August 2020 - A2
APMA News - July/August 2020 - A3
APMA News - July/August 2020 - A3
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