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How Advance Beneficiary Notices (ABNs) Used in Medicare Medical Coding and Billing

When the provider performs services or provides items that are not reimbursable and for which there is no Medicare coverage, the medical coder can bring the matter to the attention of the office management or the provider to discuss the need for something called an advance beneficiary notice (ABN). This happens because as the medical coder, you’re responsible for abstracting reimbursable procedures from the medical record.

The ABN is basically a waiver of liability that providers use when they plan to perform a service that Medicare most likely will determine is not medically necessary. The provider gives the ABN to the patient to sign.

After the ABN has been obtained, the provider can hold the Medicare patient liable for the charges. This advanced warning is Medicare’s way of insisting that providers inform their patients when Medicare may not reimburse them and alerting the patients to the fact that they will owe the entire amount billed.

Currently, providers can customize their own ABN forms as long as the forms contain the required language. Generally, the ABN must be easy to read; use a large font size; and identify the provider, the patient, the service or item in question, and the reason that payment is expected to be denied.

In addition, the patient must sign the ABN every time the service or item is provided. (You can’t have patients sign a blanket form that obligates them to pay for a service not deemed necessary by Medicare.)

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