What is the Advanced Beneficiary Notice?

 
What is the Advanced Beneficiary Notice?
 
Medicare has strict standards requiring equipment to be medically necessary and limits on how long they allow equipment to be rented or how often it can be bought. There are cases in which reimbursement from Medicare may be denied even when the company providing your equipment thinks the equipment is a medical necessity, but is not certain it will qualify because of the conditions above. If Medicare chooses not to pay, then it becomes your obligation to pay for the item. In these cases, the supplier is given the obligation to notify you that what they are ordering for you may not be covered.
 
That notice is given through an Advanced Beneficiary Notice (ABN), a form that you will be asked to sign confirming that you are aware of the fact that Medicare may not pay and that you will be liable for the costs if reimbursement does not come from Medicare.
 
Situations where a supplier may ask you to sign an ABN
 

• they believe that you may have rented the equipment before ,
• you don't know if you've ever rented the equipment before,
• the item or service is expected to be denied as not reasonable or necessary, i.e. lack of medical necessity,
• you are requesting a medically unnecessary upgrade

 
This written agreement on assigned and non-assigned claims prior to rendering the services must state the specific reason the supplier believes the services may be denied. Your supplier is not permitted to have every customer sign an ABN form as part of the delivery process, it violates the rules of CMS.
 
A new process, using the ABN described, allows HME suppliers to offer you items of higher quality than those usually covered by Medicare if you will pay the difference in price. The upgraded item must be within the range of services that are appropriate for the beneficiary's medical condition - for example an upgrade from a manual to an ultra lightweight wheelchair, but not from a cane to a wheelchair.
 
The ABN must note how the products differ and your signature notes that you agree to pay the difference in the retail costs between the two items. If you sign that ABN, the supplier may collect the difference between the charges for the upgraded item and the charges for the non-upgraded item from the beneficiary.