What is an Advance Beneficiary Notice of Noncoverage (ABN)?
The Advance Beneficiary Notice of Noncoverage (ABN) is a form issued by providers, physicians, practitioners, and suppliers to Medicare beneficiaries. In certain situations, Medicare may consider denying payment for a specific item or service. Providers must issue an ABN to transfer the financial liability to the patient in such situations. ABN helps patients make more informed decisions about whether or not to proceed with the service or item. It also enables them to accept financial responsibility for the same.
What is the primary purpose of the ABN?
The ABN enables patients and providers to be on the same page. The notice informs patients of the potential financial liability. At the same time, it helps providers seek reimbursement directly from the patients if Medicare refuses to pay for a certain service or item.
The notice must also include the reasons why Medicare would deny payment. In addition, Medicare has rolled out a set of rules about when a patient can receive an ABN and how it should look. If the provider fails to follow these rules, patients might not be responsible for the cost of the care. However, they must prove this by filing an appeal.
Examples of ABN Usage
While it can be confusing at first, these examples will help you understand the term better:
Example 1:
A Medicare patient visits their healthcare provider for an annual physical examination. The provider gives the patient an ABN before the exam, stating that Medicare does not cover routine physical exams and that the patient may have to pay for the service out of pocket. The patient will have the option to choose the service and accept financial responsibility or decline the service.
Example 2:
A patient needs a walker, but Medicare only covers certain types of walkers. The supplier provides the patient with an ABN before delivering the walker, indicating that Medicare may not cover this specific type. In this case, the patient will have the option to accept the walker and pay the cost or decline it.