Archive for December, 2011|Monthly archive page

Resolve To Use The New CMS ABN In 2012!

In Uncategorized on December 21, 2011 at 4:52 pm

The Advanced Beneficiary Notice of Noncoverage (“ABN”) is a form that is used by health care providers, including physicians, when they expect Medicare to deny payment.  More specifically, each and every time that you, the provider, believe that Medicare will deny a charge, you must have the patient complete the ABN (which is linked to a specific date of sesrvice), acknowledging that he/she has been advised that Medicare may not pay for the service, but that he/she wants the service regardless, and agrees to be financially responsible for it.  An example might be a Medicare patient seeking a complete physical (as distinguished from the annual wellness visit!) – a service that Medicare will not cover.  Having this date-of-service-specific ABN is the only way that a provider can legitimately transfer a charge that was denied by Medicare as a non-covered service to the patient for payment.

The Centers for Medicare and Medicaid Services (CMS) has revised the ABN, Form CMS-R-131. The revised form replaces ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).   The CMS website has links to the new form and instructions for use of the new ABN form, respectively: 

Use of the revised ABN form (which has a release date of 3/2011 printed in the lower left hand corner) will be mandatory starting January 1, 2012, however it is certainly available for current use as well.   Any ABNs submitted after 1/1/2012 which have a release date of 3/2008 printed in the lower left hand corner will be deemed invalid, and the patient will NOT be deemed liable for any charges that remain denied as non-covered by Medicare.