Question of the Week - ABNs

Our practice makes every Medicare patient sign an Advance Beneficiary Notice of Noncoverage (ABN) before providing treatment - is that acceptable?

Answer:  No. According to CMS (Centers for Medicare & Medicaid Services) guidelines, healthcare providers cannot require patients to sign a blanket ABN (Advance Beneficiary Notice) for all services or items. Each ABN must be specific to the service or  item that the provider believes may not be covered by Medicare.

 
A blanket ABN is a form that lists a variety of potential services or items that may not be covered by Medicare, without specifying which of them is not covered. Such a form does not meet the requirements of an ABN, which must clearly explain the reason the service or item may not be covered and provide the patient with an estimate of the cost.
 
If a provider wants to use an ABN for a service or item that Medicare may not cover, they must first conduct a coverage determination and discuss the matter with the patient. The provider must explain the reason the service or item may not be covered and provide the patient with an estimate of the cost. If the patient agrees to receive the service or item and assume financial responsibility for it, they may then sign the ABN.
 
Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, 100-4, Chapter 30 (PDF)
 
You can find the new ABN form which will become mandatory June 30, 2023 here.
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