Issuance of the ABN

50.3 - Issuance of the ABN (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) Notifiers May direct an employee or a subcontractor to deliver an ABN. The billing entity will always be held responsible for effective delivery regardless of who gives the notice. When multiple entities are involved in rendering care, it is not necessary to give separate ABNs. Either party involved in the delivery of care can be the notifier when: • There are separate “ordering” and “rendering” healthcare providers or supplier (e.g. a physician orders a lab test and an independent laboratory delivers the ordered tests); • One healthcare provider or supplier delivers the “technical” and the other the “professional” component of the same service ( e.g. a radiological test that an independent diagnostic testing facility renders and a physician interprets); or • The entity that obtains the signature on the ABN is different from the entity that bills for services (e.g. when one laboratory refers a specimen to another laboratory which then bills Medicare for the test). When the notifier is not the billing entity, the notifier must know how to direct the beneficiary who received the ABN to the billing entity for questions and should annotate the Additional Information section of the ABN with this information. It is permissible to enter the names of more than one entity in the header of the notice. Representatives of Beneficiaries If the beneficiary has a known, legally authorized representative, the ABN must be issued to the existing representative. If a beneficiary does not have a representative and one is necessary, a representative may be appointed for purposes of receiving notice following CMS guidelines and as permitted by State and Local law. When a representative is signing the ABN on behalf of a beneficiary, the ABN should be annotated to identify that the signature was penned by the “rep” or “representative”. If the representative’s signature is not clearly legible, the representative’s name should be printed on the ABN. See section 500 of this manual under “Authorized representative” for more information.