American Academy of Professional Coders (AAPC) Practice Exam

Under what circumstances is an ABN not required to be given to a patient?

1. Planned surgeries

2. Routine check-ups

3. Emergency and urgent care situations

4. Scheduled outpatient services

The correct answer is: Emergency and urgent care situations

An Advanced Beneficiary Notice of Noncoverage (ABN) is generally required when a healthcare provider believes that a service or item may not be covered by Medicare, providing patients the choice to either proceed with the service at their own expense or decline it. However, there are specific circumstances where an ABN is not necessary, particularly in emergency and urgent care situations. In these cases, immediate care is critical, and delaying treatment to provide an ABN could jeopardize the patient's health. The focus in emergencies is on providing the necessary medical care rather than discussing potential payment implications. Thus, when a patient receives care for immediate and urgent needs, the healthcare provider does not need to issue an ABN, as the nature of care often takes precedence over coverage concerns. Routine check-ups, planned surgeries, and scheduled outpatient services typically involve pre-determined services where coverage can be evaluated beforehand, thus necessitating an ABN if there's any doubt about the coverage.