What event may trigger an Advance Beneficiary Notice (ABN)?

An Advance Beneficiary Notice (ABN) is a notification that a healthcare provider gives to a Medicare beneficiary before the provision of items or services that may not be covered by Medicare. This notice is crucial when the provider believes that Medicare may deny coverage for certain services, allowing the patient to make an informed decision about whether to proceed with the care, knowing they may be responsible for payment.

In the case of a reduction in the frequency or duration of care, it may indicate that what is being provided is no longer deemed medically necessary or that the patient's condition has changed. If a provider anticipates that continued care, as previously provided, might not be covered by Medicare due to these changes, they would issue an ABN to inform the patient about the potential denial of payment, thus ensuring transparency and allowing the patient to prepare for possible out-of-pocket costs.

The other options, while relevant to patient care, do not typically activate the necessity for an ABN. Increased intensity of care and patient request for additional services suggest that the care being sought is still closely aligned with Medicare coverage policies. A delay in obtaining laboratory results, on the other hand, does not directly pertain to the services being billed or their likelihood of coverage, as the focus is on the