A Policy Statement : Advance Beneficiary Notice

999 Words Oct 12th, 2015 4 Pages
A. Policy Statement: Advance Beneficiary Notice (ABN) must be provided in accordance with Medicare requirements. ABN’s must be obtained from the Medicare patient or his/her authorized representative prior to providing any services that may be denied by Medicare. Hospitals must bill Medicare for medically necessary services and obtain an ABN for outpatient services that are not medically necessary according to Local Coverage Determinations (LCD) and/or National Coverage Determinations (NCD), except as otherwise noted in this policy.

B. Purpose of Policy: To outline the use of the Medicare ABN for laboratory tests, procedures, and other medical services that the provider believes will be deemed as not reasonable or necessary under the circumstances.

C. Procedure: In addition to Medicare rules, the guidelines set forth below must be followed to ensure that an ABN is obtained in accordance with Medicare requirements. Failure to follow these guidelines will result in an inability to bill the patient for any services that Medicare determines are not reasonable and necessary. The statements listed below outline the Medicare requirements regarding outpatient ABNs:

1. Determine if an Advanced Beneficiary Notice of Non-Coverage is required: An ABN must be obtained when one or more of the following circumstances exist:
• The procedure does not meet Medicare’s medially-necessary requirements as stated by Medicare in Federal Statutes/Regulations, or individual notice to…
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