What is the purpose of an Advanced Beneficiary Notice (ABN)?
Medicare has established guidelines to ensure that all tests or procedures performed on Medicare beneficiaries are medically necessary. When your physician writes an order for a test, he or she includes the diagnosis or reason for the test on the order. After the test is completed, we will bill Medicare for payment. Medicare requires that all claims submitted on behalf of a Medicare beneficiary include the type of test and the medical reason for the test. If the diagnosis does not meet Medicare s established criteria for medical necessity, payment for the claim will be denied. As the provider of care, it is our responsibility to notify our patients prior to testing if the diagnosis supplied by the physician does not meet Medicare s medical necessity guidelines. In these cases, you will be asked to sign an Advance Beneficiary Notice acknowledging that you are aware that Medicare may not pay the claim and accept financial responsibility for payment.
