ABN
ABN Completion
New Patient Paperwork
Day One Checklist
Day 2
100

What does ABN stand for in Medicare documentation?

What is Advance Beneficiary Notice of Non-coverage?

100

What happens if a patient refuses to select an option?

100

Who must complete the forms for a minor?

What is a parent or legal guardian?

100

What must the patient complete prior to their visit, or arrive early to complete in the office?

What is New Patient Paperwork?

100

What forms must be signed during or right after the financial consultation?

What are the Financial Plan/Office Policies and the ABN or PSR (if needed)?

200

True or False: The ABN is used for Medicare Advantage patients.

Answer: What is false? (It is for Original Medicare only.)

200

What happens if the patient checks Option 1?

What is Medicare is billed and the patient is responsible if it’s not covered,

200

What is the purpose of the Informed Consent form?

What is to explain the benefits, risks, and options related to chiropractic care, and confirm the patient agrees to treatment?

200

What box should be checked the Case Info tab for every new patient file?

What is the “Re-exam is Not Required” box?

200

What should be printed for the patient once all visits are scheduled?

What is the patient’s full schedule?

300

What is the purpose of the ABN?

What is to inform patients that Medicare may not cover certain services and transfer potential financial responsibility to the patient?

300

What is required if the patient is physically unable to check a box?

What is the notifier can mark the option with annotation at the patient's request?

300

What information does the patient provide on the disclosure consent form?

What is the names of individuals the clinic may share health or payment information with, and any restrictions?

300

What kind of note do we send if the new patient was referred by someone?

What is a thank-you note for the referring patient?

300

If a patient pays in full, what information is needed in the grey screen to reflect this?

What is pay in full amount and the amount discounted for the pat in full discount?

400

Name one type of healthcare provider that is required to issue an ABN.

What is a physician, outpatient hospital, home health agency, or hospice provider?

400

True or False: An ABN must always be signed in advance of service.


What is true?

400

If a patient refuses to sign the Acknowledgment of Privacy Practices, what should staff do?

What is document the refusal and sign as staff on the form?

400

Which scan must be printed and placed into the patient’s file on Day 1?

What is the foot scan?

400

What needs to be done if a patient is joining Apex?

What is sign up completed, $49 fee collected, APEX fee schedule added to Case Tab, and note entered with the start date?

500

Can an ABN be used in emergency or urgent care situations?

What is no?

500

What happens if a patient refuses to select an option?

What is annotate on the form they refused to choose an option?

500

What is included in the $25 New Patient Special?

What is a consultation, exam, and X-rays (if taken), and any treatment that day; Also ROF portion of visit 2?

500

A new patient’s paperwork is missing a signature on the Informed Consent. What’s the correct next step?

What is review the form with the patient, explain its purpose, and have them complete and sign it before the doctor sees them?

500

The patient agrees to treatment but only wants to schedule one visit at a time. What’s the correct next step?

What is explain the importance of pre-scheduling their full plan and offer to print the full schedule to build trust and structure?