Using ABNs for Medical Equipment and Supplies Claims When

50.10 - Using ABNs for Medical Equipment and Supplies Claims When Denials Under §1834(a)(17)(B) of the Act (Prohibition Against Unsolicited Telephone Contacts) Are Expected (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) To qualify for waiver of the Refund Requirements (RR) provision under §1834(a)(18) or §1879(h)(3) of the Act (unassigned and assigned claims, respectively), an ABN must clearly identify the particular item or service and state that the supplier expects that Medicare will deny payment for that particular medical equipment or supplies because the supplier violated the prohibition on unsolicited telephone contacts. Since it is the unsolicited telephone contact which is prohibited by law, giving notice by telephone does not qualify as notice and is not permissible. Telephone notice may not be used in this case. Since giving or mailing an ABN and obtaining the beneficiary’s agreement to pay before telephoning is equivalent to obtaining the beneficiary’s written permission for the supplier to telephone under §1834(a)(17)(A)(i) of the Act, a supplier has little to gain from using the ABN process instead of simply seeking the beneficiary’s written permission to contact him or her. If a supplier does use an ABN prior to calling, the beneficiary’s agreement to pay is essential under the Refund Requirements in order for the supplier to collect from the beneficiary. Medicare denial of payment because of the prohibition on unsolicited telephone contacts applies to all varieties of medical equipment and supplies and to all Medicare beneficiaries equally. Therefore, the usual restriction on routine notices to all beneficiaries does not apply in this case. Since unsolicited telephone contacts are expressly prohibited by statute, there is presumption of supplier knowledge of this provision. To rebut this presumption, the supplier must submit convincing evidence showing ignorance of the prohibition. A previous denial of a claim for any item furnished by a particular supplier on the basis of this prohibition is considered actual notice to that supplier. Such a denial shall be construed as actual knowledge on all future claims.