by Wyn Staheli, Director of Research
May 22nd, 2018
I have a question about a wellness ABN. Do you have to specify for repetitive or continuous noncovered care the frequency and/or duration of the item or service in the Blank D area (box in the middle of form). I have heard from other sources that Blank D (Services) box should look like (example) 24 CMT visits/1year. I was not doing them this way but another consultant group pointed out that it is in the instructions. Is this right?
"The notifier must list the specific items or services believed to be noncovered under the header of Blank (D).
- In the case of partial denials, notifiers must list in Blank (D) the excess component(s) of the item or service for which denial is expected.
- For repetitive or continuous noncovered care, notifiers must specify the frequency and/or duration of the item or service. See § 50.14.3 for additional information.
Section 50.14.3 states the following:
"50.14.3 - Repetitive or Continuous Noncovered Care
(Rev.1587, Issued: 09-05-08, Effective: 03-03-08, Implementation: 03-01-09)
Notifiers may give a beneficiary a single ABN describing an extended or repetitive course of noncovered treatment provided that the ABN lists all items and services that the notifier believes Medicare will not cover. If applicable, the ABN must also specify the duration of the period of treatment. If during the course of treatment additional noncovered items or services are needed, the notifier must give the beneficiary another ABN. The limit for use of a single ABN for an extended course of treatment is one year. A new ABN is required when the specified treatment extends beyond one year."
Notice the "if applicable" used in conjunction with the "must". Because CMT is a covered benefit which is not always payable (i.e., maintenance care) it comes down to semantics. So go ahead and state the duration and frequency, but we recommend being a little more vague and saying "up to" or "approximately" before listing a number of visits per year (e.g., up to 24 visits/12 months).