What is an ABN? An Advance Beneficiary Notice is a form that your healthcare provider is required to give if they think Medicare won’t cover a service. The ABN must be given before the service is provided.
If your provider doesn’t give you an ABN and the service isn't covered by medicare -they have not fulfilled their requirement to transfer the financial responsibility to the patient.Who, if later billed for a service that Medicare doesn’t cover, can complain to the Office of Civil Rights (OCR). The OCR is a federal agency that enforces civil rights laws.
An ABN must be on a single side of one piece of paper (in a 12 point font) and include the following:
1. Patient's name as it appears on their Medicare card
2. Provider's name, address, and phone number( TTY as well if needed)
3. An explanation of all services/items that may not be covered
4. Reason Medicare is expected to deny payment
5. Estimated cost Of the services/items
The provider must also answer any questions the patient might have.
It is valid for up to one year unless additional non-covered services are needed or treatment extends beyond that time.