Psychologists are required to provide ABNs before they provide services that they know or believe Medicare does not consider reasonable and necessary. A properly executed ABN acknowledges that coverage is uncertain or yet to be determined, and stipulates that the patient promises to pay the bill if Medicare does not. Patients who are not notified before they receive such services are not responsible for payment. The ABN must be sufficient to put the patient on notice of the reasons why the psychologist believes that the payment may be denied. The objective is to give the patient sufficient information to allow an informed choice as to whether to pay for the service.
Instructions regarding adequate written notice to beneficiaries are very stringent.
A form letter to all beneficiaries for all services is unacceptable. A general statement that Medicare denial is possible or that payment by Medicare is uncertain would also be unacceptable. Notices should only be given when there is genuine doubt regarding Medicare's payment for a particular service. 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. If Medicare denies payment, I agree to be personally and fully responsible for payment.