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FRIDAY COMPLIANCE BRIEFING: 8/16/2002

EDITOR'S WELCOME

This week begins a series of briefings based on the Center for Medicare and Medicaid Services (CMS) July 31 Program Memorandum (PM) on Advance Beneficiary Notices (ABNs). This lengthy PM discusses in detail the many requirements regarding ABNs for labs and other providers and how to use the new "official" ABN forms; CMS-R-131-G for general use, and CMS-R-131-L for laboratory use. This week's briefing discusses the question of whether frequent use of ABNs can signal a violation of the HIPAA prohibitions regarding medically unnecessary claims. As always, please feel free to forward questions, concerns, or ideas for future Friday Compliance Briefings.

Sincerely,

Charles B. Root, Ph.D.

HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT OF 1996 (HIPAA) AND THE USE OF ABNs

Section 231(e)(4) of HIPAA provides for significant penalties when providers submit claims that represent "a pattern of medical or other items or services that a person knows or should know are not medically ne....

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