Beneficiary Changes His Mind
If after completing and signing the ABN the beneficiary changes his mind, the provider should present the previously completed ABN to the beneficiary and request that he annotate the original ABN. The annotation must include a clear indication of his new option selection along with his signature and date of annotation. In situations where the provider is unable to present the ABN to the beneficiary in person, the provider may annotate the form to reflect the beneficiary’s new choice and immediately forward a copy of the annotated notice to the beneficiary to sign, date and return.
Note: In both situations, a copy of the annotated ABN must be provided to the beneficiary as soon as possible.
Beneficiary Refuses to Complete or Sign the Notice
If the beneficiary refuses to choose an option and/or refuses to sign the ABN, the provider should annotate the original copy of the ABN indicating the refusal to sign and may list witness(es) to the refusal on the notice although this is not required. If a beneficiary refuses to sign a properly delivered ABN, the provider should consider not furnishing the item/service unless the consequences (health and safety of the patient or civil liability in case of harm) are such that this is not an option.
ABN for an Extended Course of Treatment
An ABN is not needed every time for an extended course of treatment. A single ABN covering an extended course of treatment is acceptable if the ABN identifies all items/services and duration of the period of treatment for which the provider believes Medicare will not pay. If the provider believes Medicare will deny additional services furnished during the course of treatment, a separate ABN is needed.
A single ABN for an extended course of treatment is valid for one year. If the course of treatment extends beyond one year, a new ABN is needed for the remainder of the course of treatment.
Once the patient has signed the ABN, it cannot be modified or revised. When the patient needs to be notified of new information, a new ABN must be given.
ABN in a Medical Emergency
An ABN should not be obtained from a beneficiary in a medical emergency or otherwise under great duress (i.e., when circumstances are compelling and coercive). ABN usage in the emergency room may be appropriate in some cases where the beneficiary is medically stable with no emergent health issues.
How Long Should an ABN Be Kept on File?
In general, the ABN should be kept for five years from discharge/completion of delivery of care when there are no other applicable requirements under state law. Providers are required to keep a record of the ABN in all cases, including those cases in which the beneficiary declined the care, refused to choose an option or refused to sign the notice.
Claim Instructions When a Valid ABN Is On File
When the previous instructions have been followed and a valid ABN is on file, the following modifiers should be used to notify Medicare:
GA Indicates an ABN is on file. A copy of the ABN does not have to be submitted but must be made available upon request.
GZ Indicates an ABN was not signed by the beneficiary.
