Original Medicare (parts A and B) doesn't cover all health care services, including vision, hearing and dental care. However, Medicare Advantage (Part C) plans may offer coverage for some of these services. Medicare won't pay for 24-hour Home Care near Houston TX or for meals delivered to you at home. It also doesn't cover help for what are called “activities of daily living,” such as bathing, dressing, going to the bathroom, eating, or moving from one place to another in the house. While not required, the ABN provides an opportunity to let the patient know that Medicare does not cover the service and that the patient will be responsible for paying for it.
For example, in the case of a medical consultation needed at the same time as a preventive medicine consultation, you can bill for the uncovered preventive visit (excluded), but you must subtract the charge for the covered service from the charge for the uncovered service. If you're eligible, Medicaid, which states administer according to federal guidelines, may cover nursing home care. Some examples are preoperative and postoperative care when a surgery is billed or the billing for several laboratory procedures when a single panel test represents the service provided. For example, the patient wants to receive the service more often than Medicare allows or to receive a diagnosis that Medicare does not cover.
When Medicare or another payer designates a service as “combined”, it does not pay separately for parts of the combined service and does not allow the patient to bill for it, since the payer believes that the payment is already included in the payment for another service that it does cover. For example, cosmetic breast augmentation isn't covered by Medicare, but reconstructive surgery after a mastectomy is. In all cases, if the patient's policy coverage isn't clear, let them know that they may be responsible for paying for the service. Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if a doctor prescribes it for use at home.
Medicare Part A (also known as hospital insurance) can generally cover inpatient hospital care, nursing facility care, nursing home care, palliative care, and home health care. The “exclusive” option eliminates duplicate payment for these items, since you only pay once to provide the service. Nor does it cover help for what are called “activities of daily living”, such as bathing, dressing, going to the bathroom, eating or moving from one place to another in the house.
