Patient Billing Acknowledgement Form For Non-Covered Services including Maintenance/Wellness and Elective Services
Confusing as it may sound, the standard ABN form (Advanced Beneficiary Notice) is NOT needed for services that MEDICARE never covers. Rather it is used to put your patient on notice that a service MAY NOT be covered.
If you are offering services that you know Medicare, or any other plan will not, this 2-page form (one for services, one for products) spells this out so you have a signed attestation that you have notified the patient that this is a non-covered service that they will pay for privately without any submission to any carrier for potential partial or full reimbursement.
Downloadable, editable and attorney reviewed.
Terms and Conditions
By purchasing this form, we are granting you the non-exclusive use of this material. You may not re-sell or otherwise transfer the material to another therapist outside of your own practice. By virtue of submitting payment for the course, you hereby are agreeing to the following:
- Digital Product Usage -After purchasing the form, you will be given immediate access to it and will have lifetime access to use it for your own personal use and business use.2. Refund Policy- Due to the nature of the form being immediately accessible upon purchasing, no refunds of any fees or other amounts paid by you in connection with the course will be allowed under any circumstances.
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