The ABN and the Most Common CERT Error ñ “The Notifier”

The use of the Advance Beneficiary Notice of Noncoverage (ABN) allows the appropriate liability to be transferred to the patient in the event that the services do not meet reimbursement criteria. In ABN reviews performed by the CERT and other review contractors, the most common error seen involves the “Notifier(s)” section (A) of the form. Entities who issue ABNs are collectively known as Notifiers. These entities can include physicians, non physician practitioners, providers (including laboratories), and suppliers. Notifiers must place their name, address, and telephone number at the top of the ABN. When multiple entities are involved in rendering care, it is not necessary to complete separate ABNs. Regardless of who gives the notice, the billing entity will always be held responsible for effective delivery. When the notifier is not the billing entity, they must be able to direct the ABN recipient to the billing entity itself and should annotate this information in the “Additional Information” section of the ABN. ABNs that do not meet the notifier criteria are deemed invalid.

Source: https://www.noridianmedicare.com