Content provided by: Karen Zupko & Associates, Inc.
CMS just released the updated ABN CMS-R-131. The ABN should only be used for Medicare beneficiaries when a procedure or service might not be covered. The updated ABN goes into effect August 31, 2020 but you can begin using it now.
CMS added specific notifiers to the ABN instructions to include specific notifiers
Physicians, providers (including institutional providers like outpatient hospitals), practitioners and suppliers paid under Part B (including independent laboratories);
Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A
Home health agencies (HHAs) providing care under Part A or Part B
CMS also added updated information to the form instructions.
Keep in mind if the procedure or service is never covered by Medicare obtaining the ABN is not required but is optional.
Understand the instructions and guidelines for completing and executing a valid ABN.
Have the patient complete the form prior to obtaining the procedure or service.
Allow the patient adequate time to review the ABN and understand the procedure or service recommended may not be paid by Medicare for the specific circumstance.
Make sure the ABN is complete and the patient or patient’s representative signs the ABN
Provide a copy of the signed ABN to the patient or representative.
Always retain a copy in the beneficiary’s records.
Have the patient sign an ABN when checking in for his/her appointment
Have the patient sign a blanket ABN. A specific reason must be documented in Box E of the ABN form.
The updated ABN forms are available in PDF and Word format and are available in English and Spanish. There is also a separate ABN sample form for labs. The new forms along with the instructions can be found here. You should also reference CMS Publication 100-4, Chapter 30 of the Medicare Claims Processing manual which can be located here.