Advanced Beneficiary Notice (ABN) - What is it all about?
Editors Note: This is the first in a series of articles explaining the "ins-and-outs" of the ABN. Watch our Website and Listserv for future articles.
An ABN is a written notice given to a Medicare beneficiary by a physician, provider, or supplier when he or she believes that Medicare will not pay for some or all of the services or items primarily on the basis of not being medically necessary. The ABN is not designed for use when Medicare never covers a service. An ABN should be used if Medicare does cover the service for some diagnoses, but the provider's believes it will not be covered for a particular situation.
Medicare Part B has two different forms for providers to use. The ABN-G is a general notice that may be used for any service that the provider believes Medicare will not pay for based on Medical Necessity. The ABN-L is a notice for use by laboratory services only. The labs can use either an ABN-G or ABN-L.
How does an ABN protect a beneficiary?
- Allows a Medicare beneficiary to make an informed consumer decision about whether or not to receive the services or items for which he or she may have to pay out-of-pocket or through other insurance
- Allows the beneficiary to better participate in his or her own health care treatment decisions
- Protects the beneficiary from unexpected financial responsibility when Medicare is unlikely to pay for a particular service
How does an ABN protect a provider?
- Allows the provider to collect payment from the patient if the Medicare deems a service to be not medically necessary
- Provides provisions for patient refusal to sign the ABN
