An advance beneficiary notice (ABN) is a written notice to a Medicare beneficiary that Medicare may not cover a particular service or procedure. By signing the waiver, the patient acknowledges that he will pay for the cost of the procedure/service if Medicare does not.
The ABN must clearly identify the service/procedure the surgeon plans to provide and state why Medicare may not provide coverage. The ABN affects only those services/procedures you've specifically listed. You should not give an ABN to a beneficiary if you have no specific, identifiable reason to believe Medicare will not pay. Likewise, you should not give the beneficiary a blank ABN to sign and then fill in the form later.
In all cases, provide the patient with a completed and signed copy of the ABN for his records.
Helpful hint: To obtain a standardized, sample ABN, visit the CMS Web site (www.cms.gov) and use the "search" function to locate form "CMS-R-131-G"
