What is an Advanced Beneficiary Notice (ABN)?
An Advanced Beneficiary Notice (ABN) is a written notice that you may receive from physicians, providers or suppliers, before they furnish a service or item to you, notifying you: (A) That Medicare will probably deny payment for that specific service or item in your case. (B) The reason the physician, provider or supplier expects Medicare to deny payment. (C) That you will be personally and fully responsible for payment if Medicare denies payment. An ABN also gives you the opportunity to refuse to receive the service or item.
ABN is a written notice that a provider gives to a Medicare beneficiary before outpatient Part B services are furnished when the provider believes that Medicare will not pay for some or all of the services. Our staff is required to check the medical necessity of a patient’s outpatient test/procedure to determine if it meets appropriate criteria prior to the rendering of the service. If the test/procedure on the physician’s prescription does not reflect an appropriate diagnosis code per Medicare standards, the patient/guarantor will be asked to sign an ABN which states that should Medicare deny payment for this service, the patient/guarantor will accept financial responsibility and be “personally and fully responsible for payment.” To be “personally and fully responsible for payment” means that the beneficiary will be liable to make payment out-of-pocket, through other insurance, or through Medicaid or other federal payment source. We must issue notices each time and as soon as we make
