Full Definition

ABNs must be issued by Medicare providers before delivering services that are likely to be denied by Medicare — such as services deemed not medically necessary, or services that Medicare typically does not cover for a given diagnosis. The ABN names the specific service, gives a reason why Medicare may deny it, and provides an estimated cost.

Signing an ABN does NOT mean the patient agrees to pay — it means the patient acknowledges they were informed and chooses whether to proceed. Option 1 on the ABN: receive the service and potentially be billed if Medicare denies. Option 2: decline the service to avoid possible costs.

In senior care settings, ABNs may be issued for continued SNF care when Medicare coverage is about to end, for home health services that may no longer be medically necessary, or for durable medical equipment that may not meet Medicare coverage criteria.