An advanced beneficiary notice (ABN) is a written notice which a provider gives to a Medicare beneficiary before services are furnished when the provider believes that Medicare probably or certainly will not pay for some or all of the services. The ABN pertains to traditional Medicare patients only.
And ABN should be issued to the patient when a Medicare service isn’t reasonable or necessary under Program standards, including care that’s:
- Not indicated for the diagnosis, treatment of illness, injury, or to improve the functioning of a malformed body member
- Experimental and investigational or considered research only
- More than the number of services allowed in a specific period for that diagnosis (frequency)
The ABN will transfer the financial liability to the patient when the form is correctly completed and not paid by Medicare.
If the ABN is not issued when necessary or is not filled out correctly, the patient cannot not be held financially responsible for the service.
Medicare does not require the ABN for services that are not a covered benefit (services that are never covered by Medicare), however, you may use the ABN in this circumstance as a courtesy to remind patients of their financial responsibility. For information on services that are not a benefit: MLN906765 – Items & Services Not Covered Under Medicare (cms.gov)
Medicare has a new ABN form that must be used effective 6/30/2023. You can find this and the instructions for completing the form on the Medicare website with this link.
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