by Wyn Staheli, Director of Research
July 7th, 2020
The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The last mandated change took effect on June 21, 2017.
Using the New ABN
You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020. The newest version can be downloaded directly from CMS by clicking HERE.
The way to identify the correct new form is by looking at the expiration date located on the bottom left corner. The new form says (Exp. 06/30/2023).
What Changed on the New ABN?
On the actual form itself, there isn’t much that changed other than removal of some bold text found in several places throughout the instructions. However, there are quite a few changes in the official form instructions which are discussed below according to the section of the instructions:
- Added a bullet list of types of notifiers (providers/suppliers) which makes it much easier to follow.
- The language changed from primarily physicians and suppliers to also include healthcare providers and practitioners.
- Removal of the reference to the Medicare Claims Processing Manual for detailed instructions on using an ABN.
- ABN Changes
- Changed reference from the 2016 PRA submission to the “latest” PRA submission.
- Removed information about the previous update regarding section 504 of the Rehabilitation Act of 1973 and added the latest update information; “In accordance with Title 18 of the Social Security Act, guidelines for Dual Eligible beneficiaries have been added to the ABN form instructions.”
- Completing the Notice
- Removed the language about using the ABN as is, but allowing certain customization. This doesn’t mean that providers are not allowed to pre-populate certain fields. For example, the instructions for Box F still state that it is acceptable to use pre-printed items or services.
- Added instructions to NOT use the Medicare beneficiary identifier (MBI) as the patient identification number.
- Formatting of the lists has changed but the content is the same unless listed in the following bullets
- Box C: The new instructions change the information regarding SSI numbers from “must not” appear on the notice to “should not” appear.
- Box D: In the instructions regarding repetitive or continuous noncovered care, the reference to section 50.7.1 (b) of the Medicare Claims Processing Manual, Chapter 30 was removed.
- Box F: Deleted the “acceptable estimates” examples and moved the following statement to the end of the instructions (last paragraph): “CMS will work with its contractors to ensure consistency when evaluating cost estimates and determining validity of the ABN in general. In addition, contractors will provide ongoing education to notifiers as needed to ensure proper notice delivery. Notifiers should contact the appropriate CMS regional office if they believe that a contractor inappropriately invalidated an ABN.”
- Box G: Some significant changes were made to the instructions for Option 1.
- The reference to section 50.15.1 of the Medicare Claims Processing Manual, Chapter 30 was removed.
- The instructions for suppliers and providers not accepting assignment have been corrected to refer to the instructions in “H. Additional Information” instead of “D. Additional Information”
- Comprehensive instructions have been added for patients enrolled in both Medicare and Medicaid (dual enrollment)
- Box H: There were some formatting changes like making a bulleted list and paragraph formatting which help to clarify instructions.
- The following statement was added at the end of the instructions (after the “Signature Box” instructions): “CMS will work with its contractors to ensure consistency when determining validity of the ABN in general. In addition, contractors will provide ongoing education to notifiers as needed to ensure proper notice delivery. Notifiers should contact the appropriate CMS regional office if they believe that a contractor inappropriately invalidated an ABN.”