Many Medicare Advantage (Part C) plans had developed their own ABN-like forms to assist members in identifying non-covered service. These forms were required by the Advantage plans if a provider intended to collect from the patient for these non-covered services.
Medicare's ABN rules clearly state that the ABN form cannot be used under Medicare Part C. Medicare put these plans on notice – the rules for Part C are different than Part B – and the ABN form is not to be used.
United Healthcare has issued the following statement: Effective Dec. 1, 2014, the Protocol to follow to bill a Medicare Advantage member for non-covered services is:
- Member Consent: Although you can no longer use the ANN Form referenced in the Protocol, you must continue to obtain the Medicare Advantage member’s written consent to seek and collect payment from the member for non-covered services, prior to rendering the non-covered service.
- Pre-Service Organization Determination: If you know or have reason to know that a service that you are providing or referring for is not covered, you must request a pre-service organization determination for the service from UnitedHealthcare in order to bill the member for that service. UnitedHealthcare must issue a determination before you render or refer for the non-covered service. Please note that a pre-service organization determination is not required to bill a member where the member’s Evidence of Coverage (EOC) or other related materials are clear that a service is never covered.
Please check out UnitedHealthcareOnline.com for further details.
Other Medicare Advantage Plans may have similar announcements.