Advanced Beneficiary Notice (ABN)
An Advanced Beneficiary notice is a written notice that CMS requires the provider to give to a Medicare beneficiary when the provider believes that Medicare will not cover the test or procedure. The Medicare Beneficiary is required to sign this written notice, in advance of the test, to acknowledge their financial responsibility.
What’s the purpose of the ABN and when is it required
Advanced Beneficiary Notices (ABNs) are required in two cases: 1) to inform Medicare patients that we believe a service is non-covered under the CMS guidelines. Under the LCD, these cases include indications outside of CRC stages I-IV; 2) When Natera plans to bill patients for that non-covered service.
If an ABN is required, what’s the process?
Natera determines if the test is covered by Medicare and will attempt to contact the patient to obtain an ABN. Once the patient signs the ABN and selects Option 1, we are required by Medicare to bill the patient according to the EOB. If the patient selects Option 2, patients will qualify for our self-pay rates and we will not bill Medicare. No impact to test order regardless of the option selected.
When is this needed?
Under federal law, providers must inform beneficiaries in writing before performing the test when the provider believes that Medicare may not pay for the test. Therefore you will be asked to complete this form prior to services being rendered. This form allows Medicare patients to make informed decisions regarding tests ordered which may or may not be reimbursed by Medicare. The following are reasons why services may not be covered:
- Medical necessity requirements are not met
- Frequency limitations have been exceeded
- The procedure is experimental