In which scenario would an ABN likely be required?

An Advanced Beneficiary Notice (ABN) is a notice that healthcare providers must issue when they believe that Medicare may not pay for a service or procedure. The purpose of the ABN is to inform patients about the potential for non-coverage so they can make informed decisions about their care.

In the scenario where a course of treatment changes unexpectedly, the provider may foresee the possibility that the new treatment or procedure might not be covered by Medicare. For instance, if a patient initially received a treatment that was covered but later requires a different or additional treatment that is not typically covered, the provider must issue an ABN. This allows the patient to understand their financial responsibility if the new service is denied coverage.

In contrast, during scheduled preventative care appointments, individuals are typically covered under Medicare guidelines, and emergency care is generally covered by Medicare regardless of the specifics of the situation. A patient being consistently late to appointments does not influence the necessity of an ABN, as it pertains to coverage issues rather than the specific treatment being offered. Therefore, the situation involving an unexpected change in treatment is the most appropriate context where an ABN would be required.