Question: What do I do when a Medicare patient refuses to sign an ABN?

Answer: That depends on whether the patient is still demanding to have/receive the service/supply. If they aren’t demanding the service, then there is no need to force the issue. Just make sure that you still have an ABN with a note on it which states the patient refused to sign it.

However, if they are demanding the service, then even though the Medicare Claims Processing Manual, Chapter 30, Section 40.3.4.6, states that “The beneficiary cannot properly refuse to sign the ABN at all and still demand the item or service” there are a few exceptions to that statement.

The following additional information from CMS provides some guidance:

If the beneficiary or the beneficiary’s representative refuses to choose an option or sign the notice, you should annotate the original copy indicating the refusal to choose an option or sign the notice. You may list any witnesses to the refusal, although a witness is not required. If a beneficiary refuses to sign a properly issued notice, consider not furnishing the item or service unless the consequences (health and safety of the beneficiary or civil liability in case of harm) prevent this option.

So the above applies whether the patient is refusing to choose an option or just refusing to sign the ABN. Now, if they do choose an option and just refuse to sign the ABN, you have to decide if you are going to really furnish the service/supply. Technically, you could, but since chiropractic care generally is not considered essential to their health/safety it’s not going to be paid by anyone, including the patient. Therefore, it’s best to not provide the service.

One other ‘refusal’ situation that has arisen that causes some problems occurs when a patient has signed an ABN and then they change their mind. If that is the case, don’t complete another ABN. It’s better to have them mark their revision on the original ABN along with a date and signature.

Bottom line: If they are refusing to sign the ABN, note that refusal on the ABN (yes, you still need one) and just don’t provide the service since you aren’t going to get paid for it.