Practice Quiz

Medical Coding

Category - Compliance and Regulatory

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What are common reasons for Medicare to deny an item or service as “a medical necessity”, thus requiring an ABN to be issued?
  1. The service or item is experimental or investigational
  2. The service or item is not indicated for the particular diagnosis or treatment that the patient is being seen or treated for
  3. The service or item is not considered safe and effective
  4. All of the above
Explanation
Answer: D - All of the above is the correct answer. Common reasons for Medicare denial of services include the service or item being experimental or investigational, the service or item is not indicated for a particular diagnosis or treatment, and the service or item isn’t considered safe and effective.
An ABN must be issued if there is a reasonable expectation of Medicare not covering a service or item.
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