Q&A: Determining responsibility for delivering an ABN

Q: How far in advance are we required to provide an Advance Beneficiary Notice of Noncoverage (ABN)? If multiple entities are involved in ordering and providing a noncovered service such as a lab test, does each entity need to issue a separate ABN?

A: An ABN applies to Medicare Part B services and is used by hospitals and physician’s offices or practices.
The form must be issued far enough in advance of potentially non-covered items or services that apatient can consider available options and make a decision, but it is possible for the signature date and the service date to be the same. A patient just needs to have enough time to decide whether to receive
a potentially non-covered service, and he or she shouldn’t be rushed to sign it. The form must be signed and dated by a patient or his or her representative. If the date with the signature on the form is after the date of service, then the form is invalid, and a patient cannot be held financially liable. The form must be kept for five years from the date of care delivery if there are no other state law requirements that apply. If a patient refuses to sign the form, a provider should annotate the original copy of the notice indicating the refusal. A provider can list any witnesses to the refusal on ABN, but a witness is not required.
When multiple entities provide patient care, Medicare does not require them to issue separate ABNs.

However, separate ABNs can be issued under the following circumstances:

• There are separate ordering and rendering providers. For example, a physician orders a test, and
• that test is performed at the facility.
• One provider delivers a technical component of the test and another one delivers a professional
• component of the service.
• The provider that obtains the signature on the ABN is not the same entity that bills for the service.

CMS states that regardless of who issues the ABN, Medicare holds the billing entity responsible for effective and correct issuance of the form.

For more information see The Contemporary Guide to Patient Financial Services.