Protection Against Medicare-Denied Bills
An Advance Beneficiary Notice of Non-coverage (ABN) is a Medicare liability waiver that medical providers, suppliers, and independent labs are required to give to Medicare patients for services that may not be covered, or considered medically necessary, by Medicare.
The ABN lists the items or services that Medicare isn’t expected to pay for and estimates costs for those services. Once completed and signed, the patient acknowledges that they are aware that the described services may not be reimbursed by Medicare, and that they will accept responsibility for full payment if Medicare denies payment for a specific procedure or treatment.
An ABN is not used for commercial insurance companies and cannot be given to a patient who is under duress or requires emergency treatment.
ABN: Protects Providers and Patients
Given to the patient prior to any services or procedures, an ABN can protect a medical provider by providing written proof that the patient acknowledges receipt of certain procedures. With a signed ABN, providers can avoid Medicare-denied bills and account write-offs.
An ABN can protect Medicare patients by providing the patient with the opportunity to control decision making over services by either accepting or refusing service. The ABN also protects the patient from unexpected financial liability if Medicare denies payment. Further, an ABN offers the patient the right to appeal Medicare’s decision.
Legal ABN: A Short Form with Large Benefits
You can download a legal ABN from the Centers for Medicare and Medicaid Services website. Here, you can choose specific components to add to the ABN in order for it to be valid. These entries include: the patient’s name, specific service and estimated charge, as well as a number of modifiers that pertain to patient billing.
An ABN does not apply to services that are excluded from Medicare coverage, such as an annual or a refractive eye exam; and does not apply to patients who have coverage through a Medicare product provided by a private insurance company.