ABN (Advanced Beneficiary Notice)
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Monday - Friday 8:30am to 4:30pm
Learn more about when to use ABN's
A) No ABN is needed when:
- A clinical test(s) is marked "ROUTINE". Medicare will not pay for routine lab work; the patient will be responsible for payment.
- ICD9 code justifies medical necessity.
B) ABN is needed when:
- No diagnosis code or description is listed on the requisition.
- ICD9 code does not justify medical necessity.
- Frequency Test(s)
C) In order for an ABN to be considered valid, it must include the following:
- Patient name only
- Test(s) are written on the ABN form in the appropriate column ( "Medicare does not pay for these tests for your condition" or "Medicare does not pay for these tests as often as this")
- The price of the test must also be listed.
- Explain to the patient: "If Medicare denies payment, you will be responsible for payment. If you have any questions you will need to speak to your physician."
- Have the patient read, sign and date the ABN.
- Give the yellow copy to the patient.
- Send the top portion to RML Billing Office.
D) If the patient refuses to sign the ABN, but still wants testing performed:
- Another co-worker needs to be present as a witness.
- Explain to the patient - "If Medicare denies payment you will be responsible for payment. If you have any questions, you will need to speak to your physician."
- The witness and you need to sign and date the ABN at the bottom of the form.
E) If the patient refuses to have the laboratory test(s) performed, have the patient sign and date the Refusal Area.
- Notify the patient's physician that the patient refused to have laboratory test(s) collected when they were asked to sign the ABN because they did not want to be responsible for payment.
- ICD9 codes are needed for filing any insurance claim. ICD9 codes should be written next to the corresponding test(s).