American Academy of Professional Coders (AAPC) Practice Exam

What must be included in the ABN presented to the patient?

1. Procedure timeline

2. Cost estimate

3. Doctor's qualifications

4. Patient's insurance details

The correct answer is: Cost estimate

The correct answer is that a cost estimate must be included in the Advance Beneficiary Notice of Noncoverage (ABN) presented to patients. An ABN is a document that healthcare providers give to patients when they believe that Medicare may deny payment for a specific service or procedure. Providing a cost estimate is crucial because it informs patients about potential out-of-pocket expenses associated with the service. This allows patients to make informed decisions about their care and whether to proceed with the service in question, knowing what costs they might incur if Medicare does not cover it. The transparency regarding costs plays a critical role in maintaining a clear line of communication between healthcare providers and patients. While the other options may seem relevant, they do not pertain directly to the required information in an ABN. A procedure timeline may enhance understanding of when services will occur but is not mandated in the ABN. Doctor's qualifications add context to the care provided but do not influence the payment decisions and are therefore not included. Patient's insurance details, while important for billing and eligibility verification, are not required on the ABN document itself.