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A. Notifier: B. Patient Name:C. Identification Number:Advance Beneficiary Notice of Noncoverage (ABN)NOTE: If Medicare doesn't pay for D. below, you may have to pay. Medicare does not pay for everything,
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Medicare may not cover certain medical services or procedures that are not considered medically necessary.
Healthcare providers or facilities may be required to provide a reason why Medicare may not cover certain services or procedures.
Healthcare providers can fill out a form or submit documentation indicating the reason why Medicare may not cover certain services.
The purpose is to ensure that Medicare funds are being used for medically necessary services and procedures.
Information such as the medical necessity of the service, alternative treatment options, and any relevant medical records may need to be reported.
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