Medicare Advance Beneficiary Notice Of Noncoverage (ABN)

By: Edward Neeman
Published: Thursday, September 06 2018
Last Updated: 4 years ago

Visiting a healthcare provider can feel like a lesson in patience. Almost before you walk through the door, you are inundated with paperwork and forms to fill out. While it is easy to skim the forms, sign your name, and return them, there are some that you really want to pay attention to.

If you are a Medicare beneficiary with Original Medicare coverage, meaning you don’t have a Medicare Advantage plan, the Advance Beneficiary Notice of Noncoverage, commonly shortened to ABN, is one form you want to stop and look at. The Medicare ABN form has the potential to wreak havoc on your medical bills and budget.

What Is Advance Beneficiary Notice (ABN)?

The Medicare ABN is a written notification from your healthcare provider, this could be a doctor, a facility, or a hospital, that Medicare may not pay for certain items or services you will receive. In signing the Advance Beneficiary Notice form, you are accepting financial responsibility for any item or service Medicare may not or will not pay for. It is important to remember that you won’t know whether Medicare will pay until after you’ve already had the services, and Medicare has been billed.

There are some services that Medicare never pays for, things like dental care and cosmetic surgery, as well as hearing aids and eye exams. These will never be included on a Medicare ABN as it is already a given that the patient is responsible for these costs.

An example of services that could require an Advance Beneficiary Notice are things like tests that Medicare will pay for but only every other year. In another scenario, Medicare may pay for you to have a surgery on your leg, but may not pay for certain supplies or equipment needed for the procedure.

What Does The ABN Include?

A Medicare Advance Beneficiary Notice Of Noncoverage will include the services or supplies that may not be covered. The form then gives you three options:

  • Option 1: You want the items or services. With this option, your provider will bill Medicare. If Medicare doesn’t pay, you are responsible for the costs, and you are entitled to appeal the decision to Medicare.

  • Option 2: You want the items or services, but you don’t want the provider to bill Medicare. You agree to pay the cost up front, and, because no claim is submitted, you cannot file an appeal with Medicare.

  • Option 3: You decline the services or supplies. No money is due, and no claim is generated for Medicare.

Can You Be Billed If You Don’t Sign An ABN Form?

If your healthcare provider fails to furnish you with a Medicare ABN form, and you never sign an ABN, you cannot be held responsible for any resulting costs. If Medicare denies payment, the healthcare provider will be responsible for those costs.

Types Of ABN

The most common type of Medicare ABN is for services covered under Medicare Part B. These are general medical services, such as visits to your doctor’s office, diagnostic tests, or outpatient surgery. There are two other situations in which the Advance Beneficiary Notice may be called for, both falling under Medicare Part A coverage: skilled nursing care and hospital care.

Skilled Nursing Facility Advance Beneficiary Notice (SNFABN)

The SNFABN applies to patients under the care of a nursing home or skilled nursing facility (SNF). If your stay at the SNF is not considered necessary or reasonable, you will be responsible for the costs.

Generally, you will know this before entering the SNF, however, it is possible that at some point during your stay Medicare decides you no longer require care in the SNF. At that point, you may be presented with the SNFABN form and will have to decide whether you wish to stay at the facility and pay those costs or return home. In this scenario, you will not be required to pay anything until Medicare denies the claim.

Hospital Issued Notice Of Noncoverage

The final type of Medicare ABN form is the Hospital Issued Notice of Noncoverage or HINN. This is an ABN issued by a hospital when they believe your Medicare Part A will not cover all or part of your stay at the hospital. The HINN should note what the costs will be to you if Medicare denies the claim.

Non-Medicare ABN

While Federal law requires a Medicare ABN, you may encounter an Advance Beneficiary Notice of Noncoverage from other payers, such as a commercial insurance plan. This depends on the individual insurance company and their contract with your provider. Outside of Medicare an ABN is never required, but may still be used.