Outpatient Facility Coding Alert - 2020 Issue 11
ABN: Update Beneficiary Notification to Protect Your Surgeon’s Bottom Line
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Article Overview
This article covers CMS updates to the Advance Beneficiary Notice of Noncoverage (ABN) form and the surrounding beneficiary-notification guidance. It is aimed at coders, billers, and practice staff who need to understand when the updated form is relevant, how the revision affects dual eligible beneficiaries, and the general documentation and retention practices associated with ABNs. The article also addresses common compliance considerations for covered, potentially noncovered, and noncovered services, along with the role of modifiers and related Medicare/Medicaid billing workflows.
Why This Topic Matters
ABN handling affects whether providers can shift financial liability appropriately and avoid denials or invalid patient notifications. Understanding the updated form and basic usage rules helps practices reduce billing risk and maintain compliant documentation.
Article Sections
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Learn Reason for ABN Revision
Explains why CMS revised the beneficiary notification form and discusses the updated guidance for dual eligible beneficiaries. The section frames the change in relation to Medicare and Medicaid billing processes.
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Get Back to ABN Basics
Reviews general ABN use in routine practice, including when the form is typically considered, how patient communication is handled, and basic documentation expectations. It also touches on retention and availability of the signed form.
What You Will Learn
- Why CMS updated the ABN form and related guidance
- When beneficiary notification forms are generally used
- How ABN documentation is discussed for covered, potentially noncovered, and noncovered services
- What the article says about patient-facing form completion and recordkeeping
- How the article frames ABN-related Medicare and Medicaid billing considerations
Who Should Read This
- Medical coders
- Billing staff
- Surgical practice administrators
- Compliance staff
- General surgery practices
Codes Discussed
Modifiers Discussed
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