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Medical Coding News Archives

New ABN Replaces Three Previous Forms

 
May 27, 2008:
As of this September, all providers—including independent laboratories, physicians, practitioners, and suppliers—will be required to use the revised advance beneficiary notice (ABN) for all situations in which Medicare payment is expected to be denied.

Until March 3, 2008, there were two ABN forms—the CMS-R-131-G (ABN-G) and the CMS-R-131-L (ABN-L), plus a “Notice of Exclusions from Medicare Benefits” (NEMB, Form CMS-20007). The first two forms were revised and combined into one, and the third has been made unnecessary. Providers could begin using the new ABN as of March 3, 2008, but CMS is allowing a six-month transition period from the date of implementation for use of the revised form and instructions. This means that all providers and suppliers must use the revised ABN (CMS-R-131) no later than September 1, 2008.

While the previous version of the ABN was required only for denial reasons based on medical necessity, the revised version may also be used to provide voluntary notification of financial liability, which eliminates the need for the NEMB for situations in which notification is provided.

Key elements of the form are listed below:
  • The form has a new official title, the “Advance Beneficiary Notice of Noncoverage (ABN),” in order to more clearly convey the purpose of the notice.
  • It replaces both the existing ABN-G and ABN-L.
  • The form may also be used for voluntary notifications in place of the NEMB.
  • It includes a mandatory field for cost estimates of the items/services at issue.
  • It includes a new option for beneficiaries to choose to receive an item/service and pay for it out of pocket, rather than have a Medicare claim submitted.
When provided, the ABN must be verbally reviewed with the beneficiary or his/her representative and questions posed during that discussion must be answered before the form is signed. The form must be provided in advance to allow the beneficiary or representative time to consider options and make an informed choice. The ABN may be delivered by employees or subcontractors of the provider, and is not required in an emergent situation. After the form has been completely filled in and the form is signed, a copy is given to the beneficiary or his or her representative. In all cases, the provider must retain the original notice on file.

Karen H. Kachur, RN, CPC
Clinical/Technical Editor

 

 
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