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Why is the ABN important to the patient and how does the ABN prevent fraud and...

Why is the ABN important to the patient and how does the ABN prevent fraud and abuse?

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Answer #1

An ABN (Advance beneficiary notice) is used when the service provided may not be reimbursed by Medicare. If the healthcare provider believes that Medicare will not pay for some or all of the items or services, an ABN should be given to the patient.

  • The ABN must be given to the patient prior to any provided service or procedure.
  • If there is no signed ABN then you cannot bill the patient and it must be written off if denied by Medicare.

ABN protects the patient:

  • ABN gives the patient the opportunity to accept or refuse the item or service and protects the patient from unexpected financial liability if Medicare denies payment.
  • An ABN offers the patient the right to appeal Medicare’s decision
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