An Advance Beneficiary Notice of Non-Coverage (ABN) is a written document from Medicare, given to a Medicare beneficiary by a physician, provider, or supplier before receiving services.
When a physician, provider, or supplier believes that Medicare will not cover a service that he/she are about to perform on a patient covered by Medicare and if the patient still wants the treatment, their signature on the form shows they may be responsible for payment. ABN will be issued for the following reasons.
• Medicare may deny the claim for that specific procedure or treatment.
• Medicare may deny for the frequency of the service.
• You will be personally responsible for full payment if Medicare denies payment.
The ABN is not designed for use when Medicare never covers a service. It should be used if Medicare does cover the service for some diagnoses, but the provider believes it will not be covered for a particular situation.
Please note that a separate form must be signed for each service for each date of service as the patient has the option to refuse the service. And this process is best if it is managed by the clinical team, instead of the front office as specificity is required.
Medicare Part B has combined the two different ABN forms and the Notice of Exclusions from Medicare Benefits (NEMB) form into a new form CMS-R-131 for providers to use.
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