New ABN alters voluntary notification
Revised ABN replaces Notice of Exclusion
Medicare providers by now should have begun using the revised advance beneficiary notice (ABN) of coverage to let participants know when Medicare is unlikely to cover their care. Notable among the changes brought about by the revised ABN, CMS-R-131, is that it effectively eliminates most need for the Notice of Exclusion from Medicare Benefits (NEMB) when providing voluntary notification.
In the past, ABNs were only for procedures that Medicare might not cover, but didn't apply to procedures that were statutorily excluded from Medicare benefits. That was where the NEMB could be used for services that Medicare didn't cover, such as cosmetic surgery. The revised ABN form will be used for either purpose, and may be used to provide voluntary notification of financial liability.
CMS-R-131, the revised version, replaces those previously used: ABN (CMS-R-131-G) and lab ABN (CMS-R-131L). Skilled nursing facilities will continue to use ABNG until a revised SNFABN is released sometime later this year.
The new ABN includes a mandatory field for cost estimates of the items and/or services at issue, and a new beneficiary option under which the beneficiary may choose to receive an item or service and pay for it out of pocket rather than submitting a claim for Medicare coverage.
For a patient to be held responsible for non-covered Medicare expenses, providers are required to have a signed and dated ABN in the patient's file prior to any service provided by a physician or heath care professional. The ABN must be delivered far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice. ABNs are never required in emergency or urgent care situations. The beneficiary gets a copy, and the original is retained by the provider.
CMS is observing a six-month transition period from the date of implementation for use of the revised form and instructions (March 1, 2008). Thus, all providers and suppliers must begin using the new ABN no later than Sept. 1, 2008. The form and notice instructions are posted on CMS's beneficiary notice initiative Web page, www.cms.hhs.gov/bni.
Medicare providers by now should have begun using the revised advance beneficiary notice (ABN) of coverage to let participants know when Medicare is unlikely to cover their care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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