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How do I use an ABN when the Product May Not be Covered?

Posted by Linda Collins | May 12, 2017

How do I use an ABN when the Product May Not be Covered?

Give an Advanced Beneficiary Notice (ABN) to a Medicare patient when there is a chance the dispensed item may not be covered.  

You must list the items believed to be non-covered and explain, in patient friendly language, why the item may not be covered. For example, "This item is not considered medically necessary according to the Medicare program standards."

Remember to:

  • Provide the ABN in advance of providing the product to the patient.
  • Review the ABN with the patient and obtain patient's signature.
  • Retain copy in the patient's file

Download ABNs from the CMS website by clicking here.

Learn more about ABNS by clicking here.

CMS has issued detailed instructions on the use of the ABN in its online Medicare Claims Processing Manual (MCPM), Publication 100-04, Chapter 30, §50.

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