Advance Beneficiary Notices 101

What You Need to Know

An Advance Beneficiary Notice of Noncoverage (ABN) informs patients that Medicare might not cover certain services, procedures, or items, potentially leaving patients responsible for those costs. An ABN helps patients make informed financial decisions about their care.

You must issue an ABN before providing services or items likely to be denied by Medicare, typically due to:

• Non-covered services: Items or services Medicare generally does not cover.
• Medically unnecessary services: Services usually covered by Medicare, but not medically necessary for the specific patient.
• Frequency limits: Requests exceeding Medicare’s coverage policy.

When completing the ABN, (1) clearly describe the service or item, (2) explain why Medicare might deny it, and (3) provide an estimated cost the patient may have to pay. Allow the patient (or their representative) enough time to ask questions and carefully consider their options before signing the ABN. Provide the patient with a copy and retain the original.

You cannot use an ABN simply because you are unsure whether Medicare will pay a claim. Examples of these situations include:

• Uncertainty about whether the patient received a same or similar device.
• Concern about the sufficiency of your medical documentation.
• Doubts about the adequacy of a physician's supporting documentation.

 What this Means for You

Only issue an ABN when Medicare guidelines clearly identify a service as non-covered, medically unnecessary, or exceeding frequency limits. Using ABNs improperly can lead to investigations, repayment of claims, and penalties.

For help on completing an ABN, we recommend this resource from CGS.