Practice Management Alert

The ABN (Advance Beneficiary Notice) is the medical equivalent of those product disclaimers you hear at the very end of commercials. It’s a CMS-mandated waiver form that you have a patient sign when there’s a possibility that Medicare won’t reimburse the procedure or item you’re about to provide to them. That could cover services that are:

• Not deemed medically necessary.
• Exceeding frequency limits.
• Covered for certain diagnoses, but not for this patient’s diagnosis.
• Experimental only.
• Considered unsafe or ineffective.

Note: Some suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) may also have to provide ABNs under certain circumstances.

In any of these situations, signing the ABN means that the patient understands that they might have to cover the cost themselves. It lets them make a considered decision about how important this service really is to them. And having a signed ABN protects the provider from having to absorb the cost if Medicare decides not to reimburse.