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"bill unassigned" vs "ABN" - Advance Beneficiary Notice or are they the same thing?

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    "bill unassigned" vs "ABN" - Advance Beneficiary Notice or are they the same thing?

    "bill unassigned" vs "ABN" - Advance Beneficiary Notice or are they the same thing?

    Figure somebody here would know definitively what the difference is or are they the same thing?

    Different things.

    Bill unassigned essentially means the provider does not accept assignment from Medicare for the particular service or DME, and they are going to charge their own price, unrestrained by Medicare assignment (Assignment is the term for the Medicare $ reimbursement amount). They also typically collect upfront. You pay out of pocket, upfront, they bill Medicare, and the assignment $ is sent to YOU. An ABN is STILL used if anything is known or suspected of being denied!

    (Note: If they accept assignment on the product or service from one Medicare patient, they must accept it from all. It is product, and Medicare participation based, not patient based.)

    An ABN is simply a way for us to get upgrades, and for the provider to have financial liability protection. It is only used when the provider expects Medicare to deny something (usually an upgrade). If you sign it, you?re on the hook for whatever Medicare denies (which is why it is also a good idea to have an Advanced Determination of Coverage submitted first)

    An ABN is used when billing assigned or unassigned claims if there is a denial expected. No expected denial, no need for an ABN. If a DME provider is a Medicare participant they have to accept assignment, meaning they can?t bill YOU unassigned if they don?t bill EVERyONe unassigned for the same product.

    TL;DR: Assigned vs Unassigned boils down to this: The DME is either a Medicare participant, or not. If not, they bill unassigned. If so, they bill assigned. In EITHER scenario, if the claim, or any part thereof, is anticipated to be denied, an ABN form is used to inform the patient of this fact, show them by how much $, and acquire their sign off and guarantee to pay what Medicare denies. Big differences: Unassigned means paying upfront and YOU get the Medicare reimbursement. Assigned means you pay your 20% when you get the chair and the DME gets the reimbursement. Bill Unassigned is essentially the way we Medicare patients gain access to non-participating providers, but can still get reimbursement for ourselves, and the provider can still make his vacation home and boat payments.

    Here is guidance from when the ABN process was introduced, from Invacare, to its suppliers:

    Page 7, section b, is specifically about the K0004 to K0005 wheelchair upgrade.

    (NOTE: This is all very tricky and I?m not an expert. Things could be different now then when i was involved, 10+ years ago, so do your own research and read read read! Lots of info online about this process at CMS.)
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty


      Hey Oddity,

      Thank you for the response, some good information.