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Medicare ABN

The Use of an ABN in a Medical Office

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Medicare ABN
Photo courtesy of cms.gov

An ABN or Advance Beneficiary Notice is a notice Medicare requires for health care providers to issue to Medicare patients as a definite way to aware them to the fact that Medicare may not pay for certain services or tests prior to having the services or tests performed in an outpatient setting. This allows the patient to make an informed decision about whether they want to receive the services and accept full financial responsibility if Medicare does not pay.

What does this mean for the provider?

According to Medicare guidelines, a provider must provide the Medicare Patient an ABN or cannot bill them for the service if Medicare doesn't cover the service.

When an ABN is issued and signed by the patient , the provider can freely bill them for the non-covered charges. When an ABN is not issued , the provider may not bill the non-covered services to the patient.

What should be on an ABN?

There are six mandatory fields that must be filled out on an ABN to be considered valid.

  1. Health care provider's name, address and telephone number
  2. The patient name and Medicare Health Insurance Claim Number (HIC)
  3. Description of services believed to be non-covered
  4. Reason services may not be covered by Medicare
  5. The estimated cost of the services
  6. Signature of patient or patient representative and date
What if the patient refuses to sign?

If a patient refuses to sign the ABN, make sure to document the ABN with this information. Unless the service is critical to the health and safety of the patient, it may be a good idea not to perform the service.

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