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Understanding Concierge Medical Practices and ABNs

By: Amanda Howard, Esq.

Concierge medical practices offer personalized care, but they operate differently from what is considered a “regular” medical practice. Patients pay a monthly or an annual fee for special services like longer appointments and direct or quicker access to their doctor. This exclusive arrangement is intended to foster a deeper doctor-patient relationship, improve access to care and result in higher patient satisfaction levels. These “perks” generally fall outside the scope of Medicare coverage. As such, certain services provided within the concierge practice may not be reimbursable by Medicare, necessitating the issuance of an Advance Beneficiary Notices (ABN) . ABNs are like warnings for patients, telling them if a service isn’t covered by insurance, they know they’ll have to pay for the service themselves.

For practitioners operating concierge practices catering to Medicare beneficiaries, adherence to ABN requirements is critical. Practitioners must ensure that ABNs are appropriately formatted, clearly communicate the non-covered services and are provided to patients in advance of rendering the service. Failure to comply with ABN regulations can result in penalties, recoupment of payments and potential legal liabilities for the practitioner.

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