Mastering Medicare ABNs: Updated CMS Rules and Compliance Strategies

The Medicare Advance Beneficiary Notice (ABN) is a crucial form that providers must issue when Medicare may not cover certain services. However, navigating when to use an ABN—whether mandatory or voluntary—can be complex. Mistakes in issuing ABNs can lead to costly Medicare audits and penalties. In this live webinar, Expert David J. Vaughn, ESQ., will break down the latest CMS guidelines, helping you understand when and how to use ABNs correctly to protect your practice from financial and compliance risks.

Attendees will gain valuable insights on the correct application of ABN modifiers, patient rights, and how to avoid potential pitfalls with both Medicare and non-Medicare payers. Additionally, you will learn strategies that can be applied across a variety of healthcare settings, including hospitals, physician offices, and home health agencies.

Learning Objectives:

• Understand when and why an ABN must be used
• Distinguish between mandatory and courtesy ABNs
• Proper use of ABN modifiers (GA, GX, GY, GZ)
• Patient rights and provider responsibilities during the ABN process
• Recoupment issues and how to handle patient refusal to sign
• CMS guidelines for ABNs with Medicare Advantage and commercial payers
• How to keep ABNs compliant for extended treatments
• Insights into electronic vs. paper ABNs

Areas Covered:

• ABN requirements for different care settings (Hospitals, Hospice, Physicians, Home Health Agencies)
• Key updates to Medicare ABN rules and forms
• Prohibited uses of ABNs and how to avoid compliance errors
• Documentation and form requirements (CMS-R-131, HINN-1, HINN-10)
• Recoupment risks and patient billing options
• Compliance strategies for ABNs in extended treatments or with commercial payers

Who Should Attend:

• Physician Practices
• Hospital Revenue Cycle Staff
• Billing Managers and Office Staff
• Medical Billing Companies
• Compliance Officers
• Medical Coders, Billers, and Auditors
• Health Information Management Administrators
• Practice and Office Managers
• Nurse Practitioners, Physician Assistants, and Medical Assistants
• CDI Specialists
• Collection Staff and Patient Accounts Personnel

Speaker: DAVID VAUGHN

Bio:- David Vaughn, JD, CPC, ESQ, is one of the top healthcare attorneys in the United States who is the founding member of Vaughn & Associates, LLC. He graduated from Mississippi College with Special Distinction (Magna Cum Laude) in 1974, graduated from LSU Law School in 1977, and has been a certified coder since 1999. David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits.

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