New ABN (Advance Beneficiary Notice) for Medicare

CMS released a revised ABN or Advance Beneficiary Notice of Noncoverage (CMS-R-131) on March 3,2008 but providers and suppliers will be required to begin using it by September 1, 2008. This new form replaces the General Use ABN (CMS-R-131-G) and the Lab ABN (CMS-R-131-1) that were previously available. The new form and the instructions can be found on the cms web site at the following: www.cms.hhs.gov\bni

The ABN is a notice given to Medicare beneficiaries to advise them that Medicare is not likely to pay for a service or supply. Providers and suppliers must complete this form before providing services or products that are subject to this notice to the patient. The ABN must be explained to the patient or the patient’s representative and then the patient must sign the form.

One of the key features of the new form is that the title of the form, “Advance Beneficiary Notice of Noncoverage” more clearly conveys the purpose of the form. The new form replaces the need for two separate forms needed in the past. Also, this new ABN can be used for voluntary notifications instead of having the use the old separate form, the Notice of Exclusion from Medicare Benefits (NEMB).

The new ABN has a mandatory field for cost estimates. The provider or supplier must complete this field with the estimate of the cost of the service or good which may not be covered under Medicare. There is also a new beneficiary option on the new ABN form that allows a patient to choose to receive an item or service, pay for it out of pocket, and not have the claim filed with Medicare.

If you are providing services or supplies to patients that may not be covered by Medicare and are subject to the ABN you must make sure you are using the new ABN form before September 1^st. Make sure that the ABN is explained to the patient and have the patient sign the ABN. The patient should receive a copy of the ABN and a copy should be kept in the patient’s file. It is important that you have followed these steps when providing non covered services to Medicare patients.