ABNs Explained: Protecting Your Optometry Practice from Billing Risks

Running a smooth, compliant optometry practice means more than accurate diagnoses and timely prescriptions; it means understanding the fine print of billing. One key document often overlooked but critically important to revenue cycle management (RCM) is the Advance Beneficiary Notice of Noncoverage, or ABN.

Whether you’re a seasoned OD or a newly independent practice owner, understanding ABNs can protect your revenue and patient trust. Here’s why.

So, What Exactly Is an ABN?

An Advance Beneficiary Notice (ABN) is a written notice given to Medicare Fee-for-Service (FFS) patients before delivering a service that may not be covered. If Medicare decides the service is not “reasonable and necessary,” and you didn’t issue an ABN beforehand, you (not the patient) could be stuck covering the bill.

In simple terms, ABNs shift financial liability to the patient—but only if issued correctly.

This matters deeply in optometry, where certain services, like retinal photography without diabetic retinopathy or additional OCT scans beyond coverage limits, may be denied by Medicare.

ABNs & Optometry

In a typical eye care setting, it’s not unusual to:

• Conduct preventative screenings that might not be covered
• Recommend newer technologies or experimental tools
• Exceed frequency limits for repeat procedures like OCTs

Each one of these scenarios could trigger a claim denial. Without an ABN, that denial turns into lost revenue and frustrated patients. With an ABN? You’re protected, and the patient has a clear understanding of their options.

Missed ABNs = Missed Revenue

Missing an ABN doesn’t just create patient confusion; it disrupts your entire billing flow.

• Denied claims must be written off if no ABN was issued
• Patient satisfaction can drop when unexpected balances appear
• Staff time is wasted chasing appeals or explaining coverage gaps after the fact

Every claim denial shows your revenue cycle and avoidable ones like this are the most painful.

Best Practices for ABNs in Optometry

To make ABNs a seamless part of your RCM process:

1. Train your front desk and billing team on when ABNs are required (e.g., non-covered services frequency limits, new tech).

2. Standardize your ABN forms and keep digital + paper copies for compliance (minimum 5 years).

3. Add ABN checks into your pre-appointment workflow—just like insurance verification.

4. Use clear, patient-friendly language when presenting ABNs to avoid misunderstandings.

5. Track common ABN-triggered services in your EHR or billing system so you’re always one step ahead.

Clear Communication Means Cleaner Claims

ABNs aren’t just a Medicare form; they’re a communication tool and revenue protector. By understanding and implementing ABNs correctly, optometrists can safeguard their billing process, stay compliant, and ensure patients make informed decisions.

Your revenue cycle depends on more than just clean coding; it depends on clean conversations, too.