Question: When may an Advanced Beneficiary Notice (ABN) be needed and issued to a beneficiary who is not in a state of emergency?
Patient Financial Services Weekly Advisor, September 12, 2008
Answer: An Advanced Beneficiary Notice (ABN) may not be used when a beneficiary is under great duress. A beneficiary is considered to be under great duress when his or her medical condition requires emergency care. An ABN may be needed and may be used when the beneficiary is not in the state of great duress. These situations include, but are not necessarily limited to, the following:
a. A transport by air ambulance when the transporting entity has a reason to believe that Medicare is likely to deny payment on the basis that the transport could be done safely and effectively by ground ambulance transportation.
b. A level of care downgrade, e.g., from Advance Life Support (ALS)-2 to ALS-1, or from ALS to Basic Life Support, when the transport at the lower level of care is a covered transport.
a. A transport by air ambulance when the transporting entity has a reason to believe that Medicare is likely to deny payment on the basis that the transport could be done safely and effectively by ground ambulance transportation.
b. A level of care downgrade, e.g., from Advance Life Support (ALS)-2 to ALS-1, or from ALS to Basic Life Support, when the transport at the lower level of care is a covered transport.
Source: Centers for Medicare & Medicaid Services
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