ABN (Advance Beneficiary Notice)

Use an ABN to notify Medicare beneficiaries when a service may not be covered, so the patient can decide whether to proceed and accept financial responsibility if Medicare denies payment.

Purpose

• Inform patients in advance when coverage is unlikely (e.g., medical necessity not met).
• Obtain acknowledgment of potential noncoverage and patient responsibility.
• Support compliance and reduce denials-related disputes.

Common uses

• Tests that do not meet payer medical-necessity policies.
• Frequency or coverage limits reached.
• Screening vs. diagnostic distinctions.
• Experimental or non-covered services.

Benefits

• Patient transparency and informed consent.
• Clear assignment of financial responsibility.
• Better documentation for audits and appeals.
• Fewer billing delays and rework.

Using ABN in the LIS

• Order Entry Prompt: Users are prompted during order entry to generate and print the ABN for qualifying tests.
• Print Later Option: Users who skip at order entry can print later via Billing > ABN.
• Select ABN Type: From Billing > ABN, choose which type to print for Orders or for Requisitions, depending on your workflow.

Note: For ABN printing to trigger at order entry, the test-level ABN configuration must be completed first.

Configuration prerequisites

• Mark tests that require ABN based on payer rules (e.g., Medicare).
• Set any necessary ABN reasons/notes and form templates.
• Validate payer mappings so the system knows when to prompt.

Best practices

• Keep ABNs concise and specific to the tests and reasons.
• Ensure patient (or representative) signature and date.
• Include estimated costs when available.
• Retain copies with the order/requisition record and make available for billing follow-up.

Tip: If ABN prompts do not appear, verify test ABN settings and payer mappings first, then confirm you’re using the correct ABN type (Order vs. Requisition) from Billing > ABN.