During the temporary gap period, non-participating providers are permitted to submit non-assigned claims to Medicare on behalf of a beneficiary. In order to protect the supplier from liability, it is recommended to have the patient sign an ABN at the time of service, and for a rental, before each rental claim submitted. Please be sure to follow the instructions for how to submit an ABN for a non-assigned claim. - Ensure you are using the correct ABN form. The form should have a date at the bottom “Exp. 03/2020”. If you are using the old formatted form, the ABN is not valid.
- Cross out the last sentence in Section G, under option 1 with a single line.
“If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.” - Add the following statement to Section H. “This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”
- Fill out the remainder of the ABN as it would normally be filled.
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