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Medical Coding News Archives

Medicare Implements the Revised ABN

March 25, 2008:
The Centers for Medicare and Medicaid Services (CMS) has revised its Advance Beneficiary Notices (ABN) form (CMS 141G). In order to clarify the purpose of the form, it is now titled the Advance Beneficiary Notice of Noncoverage. Providers, suppliers, independent laboratories, physicians, and other practitioners began using the new ABN on March 3, 2008. The revised ABN replaces the existing ABN-G (Form CMS-R-131G) and ABN-L (Form CMS-R-131L).

ABNs must be given in writing prior to rendering a service if the provider believes that service may not be covered. If the physician or hospital does not provide an ABN and subsequently receives a denial, they may not bill the patient.

The revised ABN includes a mandatory field for cost estimates of the items or services, and the ABN will not be considered valid unless the provider makes a “good faith” attempt to estimate cost. CMS will take into consideration cases where the ordering and rendering providers are different when determining a good faith estimate.

ABNs can be used for a single item or service or multiple items or services. The name of each item or service, the reason it is not covered by Medicare, and the estimated cost must be included on the form. The revised form also includes a new option where a beneficiary can elect to receive an item or service and pay for it out-of-pocket, rather than have a claim submitted to Medicare.

CMS established a six-month transition period from the date of implementation (March 3, 2008) for providers, suppliers, independent laboratories, physicians, and other practitioners to use the revised form (CMS-R-131); so the revised ABN must be used no later than September 1, 2008. Skilled Nursing Facilities will continue to use the current ABN-G until a revised SNF-ABN is implemented.

CMS posted the revised ABN and instructions for the revised form online at www.cms.hhs.gov/bni. Related information, such as Medicare policy on billing and coding claims as well as coverage determinations, can be found on the CMS Web site at www.cms.hhs.gov.

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical Technical Editor


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