Using Advanced Beneficiary Notices

The Centers for Medicare and Medicaid Services (CMS) have developed advance beneficiary notices (ABNs) for physicians and other providers to use to alert Medicare beneficiaries that Medicare might not cover a particular service or item on a particular occasion. If a beneficiary signs the ABN, he or she is agreeing to be financially liable for any services or products that the provider believes Medicare will not cover. ABNs should be obtained in circumstances when a service or item might not be covered because it is considered not medically reasonable or necessary. Providers should also obtain an ABN when a service or item is being provided on a more frequent basis than Medicare covers.

There are two versions of the ABN. The ABN-G is to be used for general services and products and the ABN-L is to be used for laboratory services. On both forms, a specific reason for why a service or item is likely to be denied must be included.

If a beneficiary refuses to sign an ABN, the provider can indicate on the form that an ABN was given, but that the beneficiary refused to sign it. A witness’s signature should be included on the ABN. A claim for the service or item can then be submitted with a –GA modifier.

Once the signed ABN is obtained and the procedure or service performed, the provider should submit the claim. If Medicare denies payment for the claim, the provider may collect full charges from the patient.

An ABN can be used for a maximum of one year of repetitive treatment as long as the ABN specifies all services and items that Medicare may not cover for the entire year of treatment. ABNs should not be used in situations covered by the Emergency Medical Treatment and Active Labor Act (EMTALA) until the EMTALA obligation has been met.

Copies of the one-page ABNs in both English and Spanish may be downloaded from the CMS Web site at: http://cms.hhs.gov/medlearn/refabn.asp. Detailed instructions on properly completing the forms are also available on this Web site.