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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Advanced Beneficiary Notice of Noncoverage (ABN)

An Advanced Beneficiary Notice of Noncoverage (ABN) is a form given to the Medicare patient before performing healthcare services that the provider knows are not covered or that the provider thinks may not be covered by the Medicare program.   The form is used to serve as notice to the patient that 1) the service is not covered and 2) that they will be liable to pay for the service.  Members can contact us with questions about Medicare ABNs, please join us if you need assistance. 

When it is Mandatory to Issue an ABN?

When it is Voluntary to Issue an ABN?

Triggering Events (When to give the patient the ABN)

    • Initiation of Services
    • Reduction of Services
    • Termination of Services

Issuing the ABN

ABN Notice and Delivery

    • Proper Notice Requirements
    • Readability Requirements
    • Specificity, Delivery, and Receipt
    • Defective Notice
    • Timeliness
    • Effective Delivery
    • Telephone Notice
    • Capable Recipient
    • Authorized Representatives

ABN Modifiers

ABN Form and Instructions

    • Header
    • Body
    • Options
    • Additional Information
    • Signature Box

ABN Preparation Requirements

    • Language Choice
    • Effective Versions
    • Number of Copies
    • Reproduction
    • Length and Size of Page
    • Contrast of Paper and Print
    • Font
    • Customization
    • Modification
    • Retention Requirements

Routine Notice Prohibitions and Exceptions

    • Generic ABNs
    • Blanket ABNs
    • Signed Blank ABNs
    • Exceptions

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