A Medicare ABN (Advance Beneficiary Notice of No-Coverage) is a Medicare ABN. This is a notice that your supplier or medical provider sends you if they believe Medicare may not pay for certain services or items. This notice is sent to Original Medicare members. Different types of notices may be sent to beneficiaries who have Medicare Advantage or another health plan.
You must sign an ABN notice and state how you want to proceed with the services. Your provider cannot bill you for items and services that are not covered under Medicare if the ABN hasn’t been signed. They will generally not provide the care requested.
What you need to know about Medicare ABNs
What does it entail if you receive a Medicare ABN.
A Medicare ABN is a sign that Medicare may not cover the item or service you are trying to get covered. This is an advance notice that you may owe more than you think. You must sign the form before you can proceed with services.
You will be asked to choose from a number of options when you receive your ABN. Then, you will need to sign the agreement stating that you have read and understood the terms. These options include:
Make sure you pay first before you submit a claim. You may need to pay out of your own pocket if you want to keep the item or service. If the provider refuses to cover the item or service, Medicare can submit a claim. You can appeal if Medicare doesn’t cover the item, but you could owe the full amount.
Don’t file a claim if you pay first. You can opt to not have your provider file a claim if you still desire the service or item. This process does not allow you to appeal.
You can refuse the service or item. You have the option to decline coverage for a service or item not covered by Medicare. In this case, you will not owe any money. Medicare does not accept claims.
Is a Medicare ABN a sign that Medicare won’t pay me?
No. ABNs are simply a notice from a supplier or health care provider that they don’t believe Medicare will pay for the item you request. This is not an official notice from Medicare. You can appeal if a claim is made and Medicare doesn’t cover it.
However, if you decide to proceed with an item/service after signing an ABN you may be responsible for all charges.
Can I get an ABN for Medicare Advantage?
No. Only Original Medicare members can receive an ABN from suppliers and providers. Medicare Advantage plan members may be given a different type of notice by providers if a service they aren’t eligible for or no notice if the plan paperwork doesn’t clearly cover it.
What types of ABNs exist?
There are many abbreviations and more than one type of ABN. Depending on the situation, here’s what you might see.
Home Health Agency Advance Beneficiary Note: A home health agency might provide you with an ABN if you don’t need the services or items you receive.
Home Health Change of Care Notice (or HHCCN): A home health agency might give you an ABN or HHCCN if they cut or stop services for a business reason or because your doctor has changed your home care prescription.
Notice of Medicare Non-Coverage (NOMNC): Your home health agency should issue a NOMNC at least two days prior to the end of your covered services. This notice will inform you when your services will cease and the appeal process if you wish to continue.
Detailed Explanation for Non-Coverage (DENC): If you feel your services are ending prematurely, you can appeal your NOMNC and request a review from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). The DENC will be provided by your home health agency explaining why Medicare doesn’t cover you anymore.
Hospital-Issued Notification of Non-coverage (HINN): A hospital may issue a HINN if it thinks Medicare may not cover any of its Part A inpatient hospital services. This notice will tell you why Medicare doesn’t cover you and how much it would cost to pay for your services.