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Medicare ABN

what is a medicare abn

By Joy Hicks. Medical Office Expert

Joy B. Hicks, MBA, CPM, has worked in the healthcare industry since 2001, in medical billing, collections, and patient accounting. Her number one goal is to create a positive impression of the healthcare industry by promoting quality customer service.

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What does this mean for the provider?

According to Medicare guidelines, a provider must provide the Medicare Patient an ABN or cannot bill them for the service if Medicare doesn't cover the service.

When an ABN is issued and signed by the patient. the provider can freely bill them for the non-covered charges. When an ABN is not issued. the provider may not bill the non-covered services to the patient.

What should be on

an ABN?

There are six mandatory fields that must be filled out on an ABN to be considered valid.

  1. Health care provider's name, address and telephone number
  2. The patient name and Medicare Health Insurance Claim Number (HIC)
  3. Description of services believed to be non-covered
  4. Reason services may not be covered by Medicare
  5. The estimated cost of the services
  6. Signature of patient or patient representative and date
What if the patient refuses to sign?

If a patient refuses to sign the ABN, make sure to document the ABN with this information. Unless the service is critical to the health and safety of the patient, it may be a good idea not to perform the service.

Category: Insurance

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