CMS Institutes Change to ABN

Whenever one provides a service to a Medicare beneficiary, and there is reason to believe that all or part of the claim will be denied for medical necessity or other reasons, the provider must present to the beneficiary an Advance Beneficiary Notice (ABN). Many of us use this form in daily practice with our patients. This form explains to the beneficiary what service may not be paid, what the reason for expected denial is, and what options the beneficiary has. This instrument also protects the provider, by explicitly accounting for the payment responsibility of the beneficiary should they still elect to have the service rendered.

Centers for Medicare and Medicaid Services (CMS) has just released a revised version of the ABN form, conforming to a mandatory 3-year review. The new version is more clear and flexible in explaining the payment issues to beneficiaries.

From www.CMS.HHS.gov :

• Beginning Monday, March 3, 2008, providers (including independent laboratories), physicians, practitioners, and suppliers may use the revised ABN for all situations where Medicare payment is expected to be denied. The revised ABN replaces the existing ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). CMS will allow a 6-month transition period from the date of implementation for use of the revised form and instructions. Thus, all providers and suppliers must begin using the revised ABN (CMS-R-131) no later than September 1, 2008.

The new form and instructions may be downloaded from CMS at the following: http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp

Customization if the form for your specific practice and purposes is permitted and encouraged, within the guidelines found in the instructions.

Thanks to Frank West for bringing this change to the attention of our members.