In medical billing, an ABN stands for Advance Beneficiary Notice of Noncoverage. It is a notice given to Medicare beneficiaries before they receive services that Medicare is not expected to pay for.

Here's a breakdown of its key aspects:

• Purpose: To inform the patient that a service may not be covered by Medicare and give them the option to receive the service and accept financial responsibility if Medicare denies the claim.
• When it's used: An ABN is used when a healthcare provider believes that Medicare is unlikely to pay for a specific service or item due to reasons such as:
  • The service is not considered medically necessary.
  • The service is considered experimental or investigational.
  • The frequency of the service exceeds Medicare's guidelines.
• What it includes: An ABN must include specific information, such as:
  • A clear description of the service or item.
  • The reason why Medicare may not pay.
  • An estimate of the cost to the patient if Medicare denies the claim.
  • Options for the patient, including receiving the service and accepting responsibility for payment, or declining the service.
• Patient Options: The patient typically has three options when presented with an ABN:
  • Option 1: Receive the service and agree to be personally responsible for payment if Medicare denies the claim.
  • Option 2: Receive the service and request that the provider submit the claim to Medicare to see if it will pay. The patient is responsible for payment only if Medicare denies the claim.
  • Option 3: Decline the service.

For further details, you can refer to the official Medicare guidelines.