New Form Required as of March 1

Source: AAFP News Now
By News Staff
3/11/2009

Reminder to family physicians who count Medicare beneficiaries among their patients: As of March 1, CMS began using a revised version of Medicare's Advance Beneficiary Notice, or ABN, form.

The new ABN form replaces the ABN-G and the ABN-L.

The title on the new form, CMS-R-131, is "Advance Beneficiary Notice of Noncoverage." CMS determined that the inclusion of the word "noncoverage" would more clearly define the purpose of the notice.

The ABN is given to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case. An ABN is not required in emergency or urgent care situations. The physician retains the original ABN; the beneficiary receives a copy of the form.

The revised ABN of noncoverage form and instructions are available in both English and Spanish.

When completing the form, physicians should note particular formatting changes, such as the

  >  inclusion of the physician notifier's name, address and telephone number at the top of the page;

·>  inclusion (in blank "E") of at least one applicable reason why Medicare may not pay for each item or service listed; and

·>  inclusion (in blank "F") of an estimated cost of each item or service, because CMS will not consider the revised ABN valid unless the provider makes a good faith effort to estimate cost.

The revised form has three option boxes from which beneficiaries can choose. In keeping with the previous ABN, patients may check a box that says they choose to receive the items or services being offered and ask the physician to bill Medicare, or the patient may check a box refusing the items or services offered.

But beneficiaries now have a third option box, which says that they do want the items or services being offered, but asks the physician to not bill Medicare. Beneficiaries who make this latter request should understand that the choice negates any option for a beneficiary appeal.

FPs need to be certain that the beneficiary -- or a person acting on his or her behalf -- signs the notice, said Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist. In addition, the ABN must be signed before provision of the item or service, and the beneficiary should be given ample time to consider all options and make an informed choice, she added.

Hughes urged physicians to locate and use the revised ABN form. "As of March 1, the old form is no longer valid, and physicians can't hold beneficiaries responsible for charges incurred if the current ABN is not signed and on file," she said.