Question

When are providers responsible for obtaining an ABN for a service NOT considered medically necessary?

1) After a denial has been received from Medicare.
2) During a procedure or service.
3) Prior to providing a service or item to a beneficiary.
4) After providing a service or item to a beneficiary.

Answer 1

Providers must obtain an Advance Beneficiary Notice of Noncoverage prior to providing a service or item that Medicare is not expected to cover.

Step-by-step explanation:

Providers are responsible for obtaining an Advance Beneficiary Notice of Noncoverage (ABN) prior to providing a service or item to a beneficiary that is not considered medically necessary. So, the correct answer to when providers are responsible for obtaining an ABN is 3) Prior to providing a service or item to a beneficiary. An ABN is a written notice given to Medicare beneficiaries to convey that Medicare is not expected to provide coverage for a specific medical service or item, thus making the beneficiary responsible for payment should they choose to receive the service or item.