Understanding the ABN for Outpatient Therapy Services

Understanding the ABN for Outpatient Therapy Services is organized by Gawenda Seminars & Consulting, Inc. and will be held on Aug 13, 2026.

Description:
In college, therapists and assistants get very little education and training in the business and compliance aspect of outpatient physical, occupational and/or speech therapy services. If they do, it is usually limited to the basics of CPT coding, documentation and perhaps, some billing. In addition, many office managers and billing staff do not receive the proper education and training regarding when a Medicare beneficiary can be held financially liable for payment for outpatient therapy services. This course will focus solely on the advance beneficiary notice of noncoverage (ABN) form and will answer the following questions regarding the ABN:

• In what formats can I issue an ABN?
• Can I use the ABN form for my Medicare Advantage patients?
• Can I issue an ABN if I am not enrolled in the Medicare program?
• When can I issue an ABN to a Medicare beneficiary?
• When is an ABN not required to be issued to a Medicare beneficiary?
• How does the annual therapy threshold and targeted medical review impact me issuing an ABN?
• How do I complete the ABN completely and correctly?
• If Medicare ends up paying me for the services I thought they would deny, how soon must I refund the patient?
• When would I issue a voluntary ABN to a Medicare beneficiary?
• What is the difference between Option #1 and Option #2 in Section G of the ABN form?
• How does the Qualified Medicare Beneficiary Program that some Medicare beneficiaries are enrolled in effect the completion of the ABN and my ability to collect payment from the Medicare beneficiary?

Objectives:
At the conclusion of this online course, participants will:

• List the formats in which an ABN may be delivered to a Medicare beneficiary
• Demonstrate how to correctly complete an ABN and issue it to a Medicare beneficiary
• Calculate the estimated cost to the Medicare beneficiary that you expect Medicare to deny
• Identify when it is and is not appropriate to issue an ABN to a Medicare beneficiary
• Describe the difference between the 3 Options in Section G of the ABN form
• Differentiate the differences in the completion of a mandatory ABN versus a voluntary ABN
• Explain how the annual therapy threshold and targeted medical review impact your decision on issuing an ABN
• Recognize when you can and can’t collect payment from a Medicare beneficiary when an ABN has been issued
• Recall the timeframe in which you must refund payment to a Medicare beneficiary if Medicare ends up paying for the service(s) you thought they were going to deny
• Discuss how a Medicare beneficiary who is enrolled in the Qualified Medicare Beneficiary Program (QMB) may not be financially responsible even if an ABN was issued