[PDF] MLN006266 – Medicare Advance Written Notices of Non-coverage





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:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid ServicesMEDICARE ADVANCE

BENEFICIARY NOTICES

ICN 006266 October 2015

Click Here to Print

a Text-Only Version

TABLE OF CONTENTS

TYPES OF ABNS ........................................................................ ...................1

PROHIBITIONS AND FREQUENCY LIMITS

..................................................................4

COMPLETING THE ABN

...........5

COLLECTING PAYMENT FROM THE BENEFICIARY

.........................................................6

FINANCIAL LIABILITY AND THE ABN

......................................................................6

CLAIM REPORTING MODIFIERS

...7

RESOURCES

......................8 1 Please note: The information in this publication applies This booklet provides the following information on Medicare's

Resources.

TYPES OF ABN

s section below. or patient complaint that makes the service reasonable and 2 own discretion to provide guidance to the public and the medical More than the number of services Medicare allows in a

When You Must Issue an ABN

and The provider violated the prohibition against unsolicited Medicare requires an advance coverage determination, and coverage determination is made.

Non-Contract DMEPOS Suppliers

the item if it is obtained from a different supplier in the area. on 3

When You May Voluntarily

Issue an ABN

Medicare never covers or is not a Medicare

For more information about noncovered services,

located at

Three Events That Prompt Issuance of an ABN

Terminations.

Each triggering event is described in more detail below.Initiations An initiation occurs at the beginning of a new patient encounter, initiation that Medicare will not cover certain otherwise covered noncovered care.

Reductions

Terminations

wants to continue receiving care that is no longer considered prior to furnishing noncovered care.

Issuing an ABN When Multiple Entities Render Care

When multiple entities render care, Medicare does not require There are separate ordering and rendering providers 4 One health care provider delivers the technical component and another provider delivers the professional component Note:

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PROHIBITIONS AND FREQUENCY LIMITS

Routine Notice Prohibition

Medical equipment and supplies denied because the supplier had no supplier number or the supplier made an

Other Prohibitions

of a service when Medicare makes full and services.

Frequency Limits

5

Extended Course of Treatment

COMPLETING THE ABN

Completed on the approved, standardized notice format, combination of dark ink on a pale background, and the print limited customization, such as preprinting

his or her representative after he or she if he or she prefers such. You should 6 contact and subsequent attempts to obtain a signature in the must be signed and dated and include a clear indication of his or soon as possible. or Sign the ABN

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