ABN stands for Advanced Beneficiary Notice. What is its purpose?

• A. Antenatal Benefit Notification; a summary of benefits for pregnant patients.
• B. Advanced Beneficiary Notice; a notice given to Medicare beneficiaries to convey that Medicare is not likely to provide coverage in a specific case; patient would be responsible for any cost not covered.
• C. Annual Benefit Notification; informs beneficiaries of yearly limits.
• D. Allied Beneficiary Notice; indicates eligibility for multiple plans.

Answer: (B)

The main idea is that an Advanced Beneficiary Notice is a heads-up to a Medicare patient that Medicare may not cover a specific service, and that the patient could be financially responsible for the cost if Medicare denies the claim. It’s given before the service is provided so the patient can make an informed choice about proceeding or declining, with knowledge of the potential out-of-pocket expense. The notice typically explains what service is being considered, why Medicare might deny coverage, and provides an estimated cost. If the patient signs and agrees to proceed, they accept the potential responsibility for payment if Medicare does not pay; if Medicare does pay, there’s no charge to the patient. This helps prevent surprise bills and ensures informed consent for services that may not be covered.