The Equipment Supplier Hands You an ABN. Choose What Happens to the Medicare Claim Before You Sign

The equipment supplier says Medicare may not pay. Then someone hands you an Advance Beneficiary Notice of Noncoverage, usually called an ABN.

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Stop at the three option boxes.

Your choice controls whether the supplier sends a claim to Medicare. It also controls whether you can appeal a denial. The signature only confirms that you received and understood the notice. It does not choose an option for you.

This guide applies to Original Medicare. A Medicare Advantage plan uses its own coverage and appeal process. If your parent has that coverage, call the plan using the number on the member card.

Day 0, still in the bed: identify the exact item

Put the equipment order next to the ABN. The item on each paper should match.

Check the name of the item, quantity, accessories, size, model details when listed, and whether it is a rental or purchase. Do not accept a broad entry such as “medical equipment” if the supplier is providing several separate items.

CMS instructions require an ABN to identify the item or service, explain why Medicare may not pay, and provide an estimated cost. A general statement that Medicare “may not cover” does not tell you what is missing.

Ask the supplier to point to the specific reason on the form. Common paperwork problems include an item that does not match the order, missing supporting records, or a supplier that expects the item to fall outside Medicare’s coverage rules.

Ask one direct question: “Is the concern about this item, this supplier, or the records supporting the order?” Write the answer beside your copy.

An ABN is not an official Medicare denial. It is the supplier’s notice that payment is expected to be denied. Medicare makes its decision after a claim is submitted. That distinction appears in Medicare’s beneficiary protections and the CMS ABN instructions. You can keep the citation trail with this desk’s Sources.

Day 1, the car pulls in: read all three options

Option 1 means your parent wants the item and wants the supplier to bill Medicare. The supplier may request payment. Medicare will issue a decision through the Medicare Summary Notice. If Medicare denies the claim, your parent can appeal.

Option 2 means your parent wants the item but does not want a Medicare claim filed. Your parent may have to pay. There will be no Medicare decision to appeal because no claim is submitted.

Option 3 means your parent does not want the listed item. The supplier does not provide it, does not file a claim for it, and cannot charge for that listed item.

The supplier cannot select the option for your parent. CMS instructions say the patient or representative must choose one. If your parent cannot physically mark the form and asks for help, the person completing it should note what happened.

If another insurer will consider the bill only after Medicare acts, ask whether that insurer requires a Medicare decision. Option 1 produces that decision. Option 2 does not.

If your parent has Medicaid or Qualified Medicare Beneficiary coverage as well as Medicare, pause before payment. CMS has special ABN instructions for people with both programs. Ask the supplier to apply those instructions and submit the claim through the required sequence.

Day 2 to Day 3, the first full days: separate the estimate from the final bill

Copy the estimated cost from the ABN into your notes. Then ask what the estimate includes.

Check for the base equipment, accessories, delivery, setup, supplies, and recurring rental charges. Ask whether any part will be billed separately. Do not treat the ABN estimate as a Medicare decision or a final explanation of benefits.

If Option 1 was selected, keep the receipt for any payment. Ask the supplier to confirm in writing that it will submit the claim. CMS says Option 1 requires the notifier to file a claim that results in a decision your parent can appeal.

Keep four papers together:

1. The completed ABN.
2. The equipment order.
3. The delivery record showing what arrived.
4. The receipt or account statement showing what was paid.

Mark whether the supplier accepts Medicare assignment. Medicare explains that assignment affects how the supplier is paid and what the beneficiary may be charged. If the supplier does not accept assignment, read the additional wording on the ABN. Ask who receives any Medicare payment and how the supplier will credit the account.

Day 3 to Day 7, the week: confirm that the chosen path happened

Call the supplier’s billing office. Use the item name from the ABN.

Ask: “Which option is marked on your copy?” Then ask: “Was a Medicare claim submitted?” Record the name of the person who answered and the claim status they gave you.

If your parent selected Option 1 but the supplier says it will not submit a claim, send the supplier a copy of the completed ABN and request written correction. Do not switch to Option 2 over the phone unless your parent actually wants to give up a Medicare payment decision and appeal route.

When the Medicare Summary Notice arrives, match its item or service to the ABN. Read the payment decision and the reason. If Medicare denies the claim, use the appeal instructions on that notice. The ABN itself is not the appeal form.

If the equipment delivered does not match the equipment listed on the ABN, treat that as a separate paperwork problem. Ask the supplier to correct the delivery record and explain which item it billed. CMS requires durable medical equipment suppliers to keep proof showing what was delivered to the beneficiary.

Also keep the warranty information. Under 42 CFR 424.57, a Medicare-enrolled equipment supplier must honor applicable warranties and may not charge the beneficiary or Medicare for repair or replacement covered by a warranty. An ABN about expected Medicare noncoverage does not erase that supplier duty.

The page to leave on top

Write these five lines on your copy:

Exact item:
Why the supplier expects nonpayment:
Estimated cost and what it includes:
Option selected:
Who will submit the Medicare claim:

That page gives you the next task. You are not deciding whether Medicare will pay. You are deciding whether the item comes home, whether a claim is filed, and whether your parent keeps a route to appeal.