Advance Beneficiary Notice (ABN) is a notice that providers issue when a service or supply doesn’t meet Medicare’s standards for reimbursement. The ABN shifts potential financial responsibility to the Medicare beneficiary. The notice allows patients to decide whether to proceed with the service and assume financial liability if payment is denied.
EMS providers are required to issue an Advance Beneficiary Notice when they believe, based on coverage rules, that Medicare will deny payment for a service. Before providing the service, the provider must review the notice with the beneficiary and answer any questions. For the document to be valid, the patient or a representative must sign and date it. EMS providers should obtain ABN signatures for each transport, enabling them to bill patients for services not covered by Medicare.
When Should an Advance Beneficiary Notice (ABN) Be Issued?
An ABN must be issued when an item or service is deemed unreasonable or unnecessary according to Medicare guidelines. The Centers for Medicare & Medicaid Services provide the following examples:
- Care that is not indicated for the diagnosis, treatment of illness, injury, or to improve the functioning of a malformed body member.
- Care that is considered experimental, investigational or research only.
- Services exceeding the allowable number within a specific time frame for a particular diagnosis.
EMS providers must also issue an ABN in the following cases:
- Providing custodial care.
- When services exceed the beneficiary’s threshold amounts or frequency limits.
- When caring for a patient who is not terminally ill, not homebound, or does not require intermittent skilled nursing care.
For more detailed requirements, review additional conditions here.
Note: Advance Beneficiary Notice cannot be used for Medicare Advantage beneficiaries or for items and services covered under the Medicare Prescription Drug Benefit.
Issuing an ABN
When an ABN is required, providers must ensure they are using the latest version approved by the Office of Management and Budget. Additionally, providers should confirm that the patient fully understands the notice and complete all required fields. Most importantly, the beneficiary must sign and date the ABN.
If a patient or their representative refuses to sign the ABN, document the refusal on the original form. In such cases, providers should consider not providing the service unless withholding care would jeopardize the patient’s health, safety, or result in legal liability for harm.
A single Advance Beneficiary Notice can cover an extended course of treatment, but it remains valid for only one year.
For instructions on how to issue an ABN, review the guidelines here.
If you have questions regarding ABNs, contact EMERGICON via our EMS & Client Hotline: 866-839-3671 | support@emergicon.com.
EMS Patient Care Report Documentation Best Practices
ALS Vs BLS – Understanding Ambulance Services
Dangers Facing EMS: Shortage of Ambulances