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Information Articles: Medicare and Medicaid

NEW Mandatory ABN Form to Take Effect June 21, 2017

Wednesday, June 7, 2017   (0 Comments)
Posted by: Mario Fucinari DC, CCSP, CPCO, MCS-P
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NEW Mandatory ABN Form to Take Effect June 21, 2017

 

The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form.  The revised Advanced Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The revised ABN replaces the ABN Form that was last released in November 2011.

 

When a physician or supplier has a “genuine doubt” that a service will be covered, he or she is required to notify the patient of this fact.  The ABN form is required to be used for a service that is covered under Medicare.  In the Medicare program, chiropractic coverage is limited to coverage for spinal manipulation by means of the hands or hand-held device.  For all non-covered services, a standard letter (as opposed to an ABN form) informing the patient of the non-coverage, or the ABN may be used. 

 

The newly revised ABN form may be used at this time; however, its use becomes mandatory on June 21, 2017.

 

The newest version of the ABN and the instructions for use can be accessed at

https://www.cms.gov/medicare/medicare-general-information/bni/abn.html

 

The primary difference found in the newest version of the ABN form is the statement of nondiscrimination practices.  While there are no changes to the form itself, providers should be able to discern between the old version and the new version by checking the expiration date on the form.  The new expiration date on the ABN form is 03/2020.  Significantly, a new alteration in wording has been made to the ABN.  In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format, if needed.

 

The new ABN form informs the reader that, “CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call: 1-800-MEDICARE or email: AltFormatRequest@cms.hhs.gov.”

 

In view of the population diversity in the United States, the government is attempting to make the ABN understandable to all of the population.  It is important for the provider to inform the patient that, in the provider’s opinion, the services listed on the form are not expected to be covered by Medicare.  Since the services are not expected to be covered by Medicare, the liability for payment is now shifted to the patient.  Keep in mind that the form must be completely filled out, the reasoning for the expected denial must be listed on the ABN, and the cost must be listed.  Once the form is filled out, the patient must personally sign and date the form.  A copy of the completed form is then given to the patient.

 

The ABN form is actually a method for the provider to inform patients of their liability for payment.  It is only to be issued when there is genuine doubt that Medicare is going to pay for a service..  In chiropractic, since the only service covered is spinal manipulation, the ABN form is mandatory only for spinal manipulation.  One ABN form may cover a series of spinal manipulations that are not covered, but the form is not to exceed one year in length.

 

Again, keep in mind that the instructions for the use of the ABN form have not changed, but the wording has changed to reflect that the form is now available in several languages.  For a complete instruction manual on the ABN form, it is advised that you read the publication available at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Form-Instructions.pdf

 

Dr. Mario Fucinari is a member of the Carrier Advisory Committee for Medicare.  He is a frequent speaker available through NCMIC, Foot Levelers and several state associations.  Dr. Fucinari is the author of several books, and training DVDs available at www.Askmario.com  You may contact Dr. Fucinari at Doc@Askmario.com

 

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