Question

Failure to supply an ABN to a patient when required will result in:

a. The provider not being able to shift cost to the patient
b. The patient being responsible for the non-covered services
c. The provider being responsible for both covered & non covered-charges
d. The patient being responsible for both covered & non covered-charges

Answer 1

Option C. In the scenario where a provider fails to supply an Advance Beneficiary Notice (ABN), the provider becomes responsible for both covered and non-covered charges since the patient was not properly informed beforehand.

Step-by-step explanation:

Failure to supply an ABN (Advance Beneficiary Notice) to a patient when required can lead to significant issues in fee-for-service health financing systems. If a provider fails to give an ABN for services Medicare is likely to deny, this could result in the provider being held responsible for both covered and non-covered charges. The ABN is important in a fee-for-service environment, where providers are typically reimbursed for the cost of services they provide to patients.

In the context of health maintenance organizations (HMOs) and adverse selection in insurance markets, the ABN plays a different role, but the fundamental idea of ensuring that the responsible party is aware of their financial obligations regarding the provision of healthcare services remains critical. It is a clear communication tool indicating which services Medicare may not cover, leaving the patient informed about potential out-of-pocket costs.