MEDICARE ADVANCE BENEFICIARY NOTICE
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THIS PAGE SHOWS THE MEDICARE ADVANCE BENEFICIARY NOTICE (ABN), REQUIRED FOR REIMBURSEMENT, WITH LINKS TO SERVICES.

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MEDICARE - ABN Notice Sample
MEDICARE - Blood Test Reimbursement and Coverage
MEDICARE - Blood Transfusion Reimbursement and Coverage

BloodBook.com provides on this page, as a service to our visitors, a sample representation of the Medicare Advance Beneficiary Notice (ABN) form that you will be required to sign in order to ensure that reimbursement is made for your Blood testing and some other limited Blood services. Medicare and Medicaid will pay for Blood testing only under certain conditions.

Unexpected changes in Medicare rules can affect reimbursement schedules, and differ substantially by state, county, date, eligibility and qualification requirements. You must follow the rules if you want Medicare to pay your bills.

Before you commit to anything, be certain, as always, to check with Medicare at the numbers that we have provided below.

This form is important. We present a typical sample here so that you will be able to become familiar with it before you are expected to understand and sign it.

If the ABN Form is not properly completed and the other required paperwork is not submitted on the claim, the laboratory is NOT PERMITTED TO BILL THE PATIENT FOR THE SERVICE. Basically, the laboratory has then performed a FREE service.

We have provided an actual Advance Beneficiary Notice (ABN) HERE.

You should NEVER be asked to sign a "blanket" ABN Form that neither specifies the test or service, nor provides the reason why the particular claim may be likely to be denied. If these important components of the form are not filled in, you do not have enough information to make the required "informed decision." 

KEEP A COPY of everything that you sign..... your doctor does.

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SAMPLE Typical Advance Beneficiary Notice (ABN)

Physician/Supplier notice:

Medicare will only pay for services that it determines to be "reasonable and necessary" under section 1862(a)(1) of the Medicare law. If Medicare determines that a particular service, although it would otherwise be covered, is "not reasonable and necessary" under Medicare program standards, Medicare will deny payment for that service. The opinion of this facility is that, in your case, Medicare is likely to deny payment for ( _____ particular services outlined here _____ ) for the following reasons: ( _____ specific reasons must be stated here for predicting that Medicare will deny payment _____ ) .

Beneficiary agreement:

I have been notified by my physician/supplier that he or she believes that, in my case, Medicare is likely to deny payment for the services identified above, for the reasons stated. If Medicare denies payment, I agree to be personally and fully responsible for that payment.

 

Signed,

 

(Beneficiary Signature)

 

OMB Approval No. 0938-0566. Expiration Date: 8/31/02. Form No. HCFA-R-131

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Link - BloodBook.com Information on the Advance Beneficiary Notice Quick Reference Guide is available from the HCFA web site HERE. Link - BloodBook.com

Link - BloodBook.com Medicare Blood Transfusion Information Link - BloodBook.com

Link - BloodBook.com Medicare Blood Testing Information Link - BloodBook.com

We have provided an actual Advance Beneficiary Notice (ABN) HERE.


For More Information.....

Call 1-800-MEDICARE (1-800-633-4227)  24 hours.

Call 1-877-486-2048 for hearing and speech impaired. 

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   last updated 03/10/2013   bloodbook.com