Question

the supplier or provider should generate an advance beneficiary notice (abn) if they believe that a claim for the services is likely to receive a:
○ a. medical necessity denial
○ b. limiting charge
○ c. medicaid remittance advice
○ d. concurrent review

Explanation:

An Advance Beneficiary Notice (ABN) is used when a provider believes Medicare may deny a claim for lack of medical necessity. ABNs inform patients they may be responsible for payment if Medicare denies the claim. Limiting charge (b) relates to Medicaid and private insurance, not ABNs. Medicaid remittance advice (c) is a payment notice. Concurrent review (d) is a utilization review process during treatment.

Answer:

a. medical necessity denial