An ABN needs to be signed anytime prior to the service being rendered, if you feel that it will not be covered. The reason you think it may not be covered needs to be specifically stated and the earlier in the process you get it signed the better. Medicare wants to know that the patient had time to make an informed decision regarding obtaining or refusing the test. If you schedule the patient for a test and you think it might not be covered, but don't inform the patient of this until he/she shows up for the exam, the patient can't really make an informed decision about having it done, he/she is now under pressure to decide. It's much better to be able to sit down with a patient and explain why the test is necessary, what is the reationale behind it, but why even if it might be needed medicare may not pay for it.
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