CMS Pub. 100-04, ch. 30, § 50.15

Collection of Funds

A beneficiary’s agreement to be responsible for payment on an ABN means that the

beneficiary agrees to pay for expenses out-of-pocket or through any insurance other than

Medicare that the beneficiary may have. The notifier may bill and collect funds from the

beneficiary for non-covered items or services immediately after an ABN is signed, unless

prohibited from collecting in advance of the Medicare payment determination by other

applicable Medicare policy, State or local law. Regardless of whether they accept

assignment or not, healthcare providers and suppliers are permitted to charge and collect

the usual and customary fees; therefore, funds collected are not limited to the Medicare

allowed amounts.

If Medicare ultimately denies payment of the related claim, the notifier retains the funds

collected from the beneficiary unless the claim decision finds the healthcare provider or

supplier liable. When Medicare finds the healthcare provider or supplier liable or if

Medicare or a secondary insurer subsequently pays all or part of the claim for items or

services previously paid by the beneficiary to the notifier, the notifier must refund the

beneficiary the proper amount in a timely manner.