An Advanced Beneficiary Notice of Non-coverage (ABN) is a document from Medicare to determine responsibility of a procedure that might not be covered under Medicare. Occasionally, your doctor will send you for a test that Medicare might not cover.
The provider who verifies the benefits will issue an ABN at the time of service to let the patient decide if they want to proceed with the procedure knowing this information. The provider is not allowed to pick an option for the patient, so it’s important for the patient to know what options they have.
A valid ABN requires that you, the patient, sign that you understand the following:
-The service you are having
-The reason Medicare may deny
-The cost of the procedure
-Your options (there are three)
Medicare may deny your service for any number of reasons, including frequency limitations, unnecessary screenings, or medical necessity. If the provider is telling you Medicare might not cover the service, make sure you understand your choices:
Option 1: Option 1 is the most common option. This option means you want the test done, and the provider can bill Medicare, but you will be responsible for the procedure if Medicare doesn’t pay. Talking to the provider upfront about payment arrangements (if Medicare doesn’t pay) is the safest way to keep your account from going to collections. However, Medicare does have a patient appeal option in the Medicare Summary Notice. When submitting your appeal, it’s important to include your medical records and doctor’s orders. A letter from your doctor explaining the medical necessity of the procedure will almost always get Medicare to reverse their decision. If/when Medicare overturns their decision, contact the provider’s office for your money back.
Option 2: Option 2 means you want to have the test done, but don’t bill Medicare. This option could be a valid option for you if the self-pay price is cheaper and more affordable than the retail cost of the procedure. However, it’s important to ask the provider if they will let you pay the Medicare price. Medicare’s allowable is often even less than the self-pay price, and most providers will allow you to pay this amount if you pay in full at the time of service.
Option 3: Option 3 means you don’t want the test done at all. It means you aren’t having the procedure done and you don’t want Medicare billed. At this point in registration, you may have already paid your estimated amount. If it’s not possible for the provider to void the transaction, then make sure you get the phone number for the business office refunds department and have your payment confirmation number and medical records number ready. This will help the refunds department to track and refund your payment.
Utilizing Medicare resources is the best way for you to understand your Medicare Part B benefits and the options you have as a Medicare patient. This website will tell you about special restrictions, covered screenings, Part C plans and the like. You can also contact 1-800-MEDICARE, and they can answer any questions you might have about the Advanced Beneficiary Notice of Non-coverage.