Five Facts on Advance Beneficiary Notices

 In Articles, Coding & Documentation, Policy Updates

An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover. Take a look at these other five facts about ABNs.

  1. ABN’s are not to be used for services provided under a Medicare Advantage plan.
  2. A provider may not bill a Medicare Advantage member for non-covered services unless the member has received a “pre-service organization coverage determination” prior to the service
  3. Each Medicare Advantage plan will have their own process for providing these pre-service determinations
  4. The member OR provider can request the determination, but the burden ultimately falls on the provider because the member may not be billed unless the coverage determination is made prior to the service being provided
  5. This is a federal mandate and the use of ABNs should be discontinued for all Medicare Advantage members

For more information, visit the CMS website.

To learn more from a payor perspective, visit BCBSNC.

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