Medicare is expected to deny a physician-office service as not medically necessary. When is an Advance Beneficiary Notice of Noncoverage (ABN) appropriate?
Select an answer to reveal the explanation.
Short Explanation
An ABN is a before-the-shot conversation, not a after-the-denial surprise invoice. If Medicare’s likely to say “not medically necessary,” give the notice first. That way the patient chooses with eyes open.
Full Explanation
CMS requires a valid ABN before furnishing an item or service that the provider believes Medicare will deny as not reasonable and necessary (among other ABN-triggering situations). The notice shifts financial liability to the beneficiary only when completed properly in advance. Issuing an ABN after the service or only after denial generally fails to protect billing rights under Medicare rules.