CMS Pub. 100-04, ch. 30, § 50.3

Notifiers May direct an employee or a

subcontractor to deliver an ABN. The

billing entity will always be held

responsible for effective delivery

regardless of who gives the notice.

When multiple entities are involved in

rendering care, it is not necessary to

give separate ABNs. Either party

involved in the delivery of care can be

the notifier when:

• There are separate “ordering” and

“rendering” healthcare providers or

supplier (e.g. a physician orders a

lab test and an independent

laboratory delivers the ordered

tests);

• One healthcare provider or supplier

delivers the “technical” and the other

the “professional” component of the

same service ( e.g. a radiological test

that an independent diagnostic

testing facility renders and a

physician interprets); or

• The entity that obtains the signature

on the ABN is different from the

entity that bills for services (e.g.

when one laboratory refers a

specimen to another laboratory

which then bills Medicare for the

test).

When the notifier is not the billing

entity, the notifier must know how to

direct the beneficiary who received the

ABN to the billing entity for questions

and should annotate the Additional

Information section of the ABN with

this information. It is permissible to

enter the names of more than one entity

in the header of the notice.

Representatives of Beneficiaries If the beneficiary has a known, legally

authorized representative, the ABN must

be issued to the existing representative. If

a beneficiary does not have a

representative and one is necessary, a

representative may be appointed for

purposes of receiving notice following

CMS guidelines and as permitted by State

and Local law. When a representative is

signing the ABN on behalf of a

beneficiary, the ABN should be annotated

to identify that the signature was penned

by the “rep” or “representative”. If the

representative’s signature is not clearly

legible, the representative’s name should

be printed on the ABN. See section 500

of this manual under “Authorized

representative” for more information.