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Advance Beneficiary Notice (ABN) Resources
ABN Form (PDF)* CMS update Both ABNs have
customizable boxes which may be preprinted with check-off items. The two boxes
on the general use form are used to indicate the items or services and reasons Medicare
probably will not pay. The laboratory version
contains three boxes, the first is used to select or list a specific test
which is not covered because of local or national coverage policy. The second
box is used to select or list a test that may be denied based on frequency
limits. The third box is used to identify research only or
experimental tests which probably will not be covered. A list of
tests can be preprinted in each box and selected as appropriate. The Estimated Cost item
is optional, lack of an entry or a value different from the actual cost billed
to the patient does not invalidate the ABN. At least two copies
of the ABN are required, the original is retained by the provider and a copy
given to the patient. If a beneficiary refuses
to sign an ABN, but demands that the service be provided, a witness can make
a note to this effect and sign the ABN. The beneficiary will then be responsible
for the service if it is subsequently denied. A patient must be
notified far enough in advance to make a rational decision, without undue
pressure, as to whether they want a test or service and are willing to
pay for it. Patients should be given an ABN before they are prepped for a
procedure or otherwise put in a position where they feel they can not reasonably
refuse treatment. ABNs should never be given to trauma patients or in any
EMTALA situation. ABNs given to patients under great duress are not valid. A single ABN can be used
to cover multiple services performed as part of a standing order or course of
treatment. For example, if a patient is scheduled for a PT test once a
month, a single ABN can be used. In this case the ABN would be justified
because of the frequency limits imposed on PT testing. A single ABN will
also cover both the technical and professional components of a pathology or
radiology procedure. When Medicare denies
a service for which an ABN is on file, Medicare does not limit the amount the
provider can collect from the patient. However, billing a very low amount
(for example, significantly below what Medicare would pay) might be
considered an inducement and implicate violation of the anti-kickback law.
Likewise, if ABNs are NOT furnished with the intent to induce referrals for
other Medicare services, the anti-kickback law may be violated. |
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