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What good is an ABN?

Jenny Posted Mon 12th of October, 2015 16:34:22 PM

I thought that an ABN was signed by the patient knowingly that "IF" services are not paid for by the insurance(for whatever reason) that the patient then knows that they may be responsible for a portion that is due. (i.e.- say someone comes in for a visit and then a shot also takes place. You and I both know that they will pay for the cheapest one) I need more elaboration on what the ABN is used for please?

SuperCoder Answered Tue 13th of October, 2015 11:03:04 AM

Well, Waiver of liability or Advance Beneficiary Notice (ABN), is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover. ABNs only apply if you have Original Medicare, not if you are in a Medicare Advantage private health plan. The ABN may look slightly different, depending on what type of provider you received it from. Providers must give you an ABN when the service or item could be covered by Medicare, but the provider expects that Medicare will not find the care to be medically necessary and will, therefore, deny coverage. The ABN must list the reason why the provider doubts Medicare will cover care. For example, an ABN might say- Medicare only pays for this test once every t year. Providers are not required to give you an ABN for services or items that are never covered by Medicare, such as spectacles after glaucoma surgery. The ABN serves as warning that Medicare may not pay for the care your provider recommends. However, it is still possible that Medicare will approve coverage. To get an official decision from Medicare, you must first receive the care and sign the ABN form, agreeing to pay for it yourself if Medicare rejects coverage. On the other hand, to have a chance of receiving Medicare coverage, you must select option 1 on the ABN form. Selecting this option requires your provider to bill Medicare after providing you with the service or item. If you do not select option 1 on the ABN, you have no chance of Medicare coverage because your doctor is not required to submit the claim. Hope it helps!

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