Certified Revenue Cycle Representative (CRCR) Practice Exam

When might an ABN be issued to a Medicare beneficiary?

1. When the patient has reached their annual deductible

2. When a service is deemed unnecessary

3. When the expected payment is below a certain threshold

4. When there is a likelihood of denial of coverage for a service

The correct answer is: When there is a likelihood of denial of coverage for a service

An Advance Beneficiary Notice of Noncoverage (ABN) is issued to a Medicare beneficiary when there is a likelihood that Medicare will deny coverage for a particular service or item. This notice informs the beneficiary that the service may not be covered by Medicare and that they may be financially responsible for the costs associated with the service if it is determined to be not medically necessary or otherwise outside of coverage guidelines. Issuing an ABN allows beneficiaries to make informed decisions about their care, and it places them in a position to agree to receive services that they might otherwise forgo due to uncertainty about coverage. The ABN specifically addresses scenarios where the healthcare provider believes that the service may not be covered based on prior determinations, medical necessity criteria, or specific guidelines that Medicare enforces. In the context of the other options, reaching an annual deductible does not inherently lead to the issuance of an ABN since the deductible is a cost-sharing mechanism and does not imply a decision about coverage. A service deemed unnecessary means it may not qualify for coverage, but the ABN is specifically for informing patients about services likely to be denied beforehand. Lastly, while payment thresholds could impact coverage decisions, this does not directly correlate with the primary purpose of the ABN, which centers on