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Course Title: Advance Notification of Medicare Noncoverage
Course Series: eComply Healthcare

Description:

Healthcare providers may face instances when products or services that they provide to Medicare beneficiaries will not be or are unlikely to be reimbursed by Medicare. Often such services will not be medically reasonable or necessary. Generally, providers that furnish healthcare services with this knowledge will bear the cost of the service.

However, healthcare providers may preserve their right to be reimbursed for services provided to beneficiaries when such services are not reimbursable by the Medicare program. Medicare Part B providers may use an Advance Beneficiary Notice (ABN) to inform a beneficiary of the following:

1. Medicare is unlikely to reimburse a particular service.
2. They will be personally liable to pay for the service.

Similarly, hospitals may use a Hospital-Issued Notice of Noncoverage (HINN) to provide notice to a beneficiary that Medicare will not reimburse for a certain service and that the beneficiary will be liable to pay the costs of the service.

The purpose of this lesson is to assist healthcare providers in understanding when it is appropriate to use either an ABN or an HINN. In addition, this lesson will illustrate the elements that ABNs and HINNs must contain in order to provide effective notice to beneficiaries that Medicare is unlikely to, or will not, reimburse for a healthcare product or service.

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