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The document is an Advance Beneficiary Notice of Noncoverage (ABN) from Carter Chiropractic Center, LLC, informing patients that Medicare may not cover certain chiropractic services. It outlines specific services that are not covered by Medicare, their estimated costs, and provides options for patients to choose regarding billing and payment responsibilities. Patients are advised to read the notice carefully and ask questions before making a decision.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

When should an ABN be issued?

An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

Is an ABN required for commercial insurance?

ABNs are not used for Medicare Advantage, Managed Medicaid, commercial, or Part D plans.

Who fills out the ABN form?

Entities who issue ABNs are collectively known as notifiers, which can include physicians, practitioners, providers (including labs) and suppliers, and utilization review committees. If you reproduce the ABN, remove the letters before issuing it to the patient.

What happens if ABN is not signed by patient?

If a patient refuses to sign a properly issued ABN, consider not providing the item or service unless the consequences (health and safety of the patient or civil liability in case of harm) prevent it.

Can you bill a patient without an ABN?

ABNs are mandatory only if you want to bill the patient for a service you think may not be covered by Medicare.

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Where can I get an ABN form?

With the latest PRA submission, a minor change has been made to update the nondiscriminatory language. ABNs may be downloaded from the CMS website at: .

When should an ABN not be issued?

An ABN cannot be used to transfer liability to the beneficiary when there is a concern that a billing requirement may not be met. (For example, an ABN cannot be issued at initiation of home care services if the provider face-to-face encounter requirement is not met.)