CMS approves updated Advanced Beneficiary Notice
of Noncoverage (ABN) for Use
CMS recently approved the CMS-R-131 Advanced Beneficiary Notice of Noncoverage as the replacement notifier for the general ABN (CMS-R-131-G) and laboratory ABN (CMS-R-131-L) as of March 3, 2008. Medicare has allowed a six-month transition period and all users are required to implement the new form by September 1, 2008. The new form is very similar to the ABN-L, but providers should be aware of a few changes.
Providers will be required to list the tests/procedures that may not be covered, the reason for denial and estimated cost of procedures in the three boxes provided in the body of the ABN. While the listing of estimated cost was optional in the past, the ABN (CMS-R-131) will now be considered invalid if this section is not completed. Beneficiaries are allowed to choose which service(s) they wish to receive by striking through the listed service, reason for denial, and cost of those tests that they do not elect to receive.
One of the most noticeable changes in the form is the addition of a third option regarding the receipt of the potential non-covered service. The options are as follows:
▪Option 1: Opt for the service requesting that the provider bill Medicare
▪Option 2: Opt for the service, requesting that the provider not bill Medicare
▪Option 3: Refuse the service
Patients accept financial responsibility for the service(s) when option 1 or 2 is selected, and providers may ask the patient to submit payment on the date the service is rendered. Should Medicare reimburse the service, providers would be responsible for issuing refunds to the patient. At this time, it is unclear how laboratories would receive payment submitted on the date of service when notices are executed by referring physician offices. It is also important to note that patients choosing option 2 are not allowed to appeal to Medicare regarding a decision on coverage of service.
Copies of the new ABN form and instructions for use can be downloaded from the CMS website at http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage. You may also click here to download a PDF of the new form.