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Issuing the ABN

Issuers of ABNs (Notifiers)

Entities who issue ABNs are collectively known as “notifiers”. These entities can include physicians, practitioners, providers (including laboratories), and suppliers, and/or utilization review committees for the care provider.

 The notifier may direct an employee or a subcontractor to deliver an ABN. The billing entity will always be held responsible for effective delivery regardless of who gives the notice. When multiple entities are involved in rendering care, it is not necessary to give separate ABNs. Either party involved in the delivery of care can be the notifier when:

    • There are separate “ordering” and “rendering” providers (e.g. a physician orders a lab test and an independent laboratory delivers the ordered tests);
    • One provider delivers the “technical” and the other the “professional” component of the same service ( e.g. a radiological test that an independent diagnostic testing facility renders and a physician interprets); or
    • The entity that obtains the signature on the ABN is different from the entity that bills for services (e.g. when one laboratory refers a specimen to another laboratory which then bills Medicare for the test).

When the notifier is not the billing entity, the notifier must know how to direct the beneficiary who received the ABN to the billing entity for questions and should annotate the Additional Information section of the ABN with this information. It is permissible to enter the names of more than one entity in the header of the notice.

Recipients of the ABN

Notifiers are required to give an ABN to a FFS Medicare beneficiary or his/her representative before providing him/her with a Medicare covered item or service that may not be covered in this particular instance or before providing custodial care. Recipients of ABNs include beneficiaries who have Medicaid coverage in addition to Medicare (i.e. dual-eligible). A notifier’s inability to give notice to a beneficiary or his/her representative does not allow the notifier to shift financial liability to the beneficiary.

Representatives of Beneficiaries

Notifiers are responsible for determining who may act as a beneficiary’s authorized representative for the purposes of ABN issuance under applicable State or other law. An individual who may make health care and financial decisions on a beneficiary’s behalf (e.g. the beneficiary’s legal guardian or someone appointed according to a properly executed “durable medical power of attorney”) is an authorized representative. If the beneficiary has a known, legally authorized representative, the ABN must be issued to the existing representative. If a beneficiary does not have a representative and one is necessary, a representative may be appointed for purposes of receiving notice following CMS guidelines and as permitted by State and Local law.

When a representative is signing the ABN on behalf of a beneficiary, the ABN should be annotated to identify that the signature was penned by the “rep” or “representative”. If the representative’s signature is not clearly legible, the representative’s name should be printed on the ABN.

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