Q&A: Patient Choices After ABN Delivery

Q: What options for care/coverage does a patient have after receiving an Advance Beneficiary Notice (ABN)?

A: Registration or case management staff members at the hospital often deliver and communicate information about the ABN, which is sometimes used if it appears the hospital visit itself won’t be covered. A patient might insist on being admitted even if the stay won’t be covered but then agree to another plan when he or she realizes the financial liability involved.

The patient should sign and date the ABN to indicate that he or she understands it. After that point, he or she may decide to do one of the following:

• Decline the service.
• Pay out of pocket for the service.
• Pay for the service out of pocket and submit the bill to Medicare. If Medicare denies the claim, the patient can then appeal the decision.

For more information, refer to the Observation Services Training Handbook.

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