Outpatient Facility Coding Alert - 2017 Issue 5
Advance Beneficiary Notices: New ABN Form Effective June 2017
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Article Overview
This article explains Medicare Advance Beneficiary Notice (ABN) form updates effective in June 2017 and the practical context in which ABNs may be relevant outside emergency care. It covers the form’s revised notice language, expiration timing, and the general information providers must include when notifying beneficiaries that a service may not be covered. The article is useful for emergency department leaders, urgent care and office-based practices, and billing or coding staff who need to understand current ABN form requirements and payer-specific variations.
Why This Topic Matters
ABN forms affect how providers communicate potential noncoverage to Medicare beneficiaries and document patient notification before non-emergent services are delivered. Understanding the current form and its required elements helps organizations stay aligned with CMS expectations and avoid administrative problems when services may not be covered.
Article Sections
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Overview of ABN use in non-emergent settings
Introduces the Medicare ABN context and explains why these notices are generally uncommon in emergency department workflows. It also notes the types of non-emergent settings where ABN awareness may still matter.
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Form update and approval cycle
Summarizes the June 2017 form update, the addition of alternate-format request language, and the form’s renewal process under federal paperwork requirements. It also mentions the updated expiration date on the form.
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Required notice content and cost estimate guidance
Describes the general information the notifier must communicate to beneficiaries when a service may not be covered, including the need for a reasonable estimate of expected charges. It also covers CMS examples of acceptable estimate language and the treatment of grouped items or services.
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Payer-specific ABN forms
Notes that other payer types may use their own ABN forms and that providers should monitor updates from contracted payers.
What You Will Learn
- When ABNs are generally relevant and when they are not
- What changed on the revised Medicare ABN form
- What information the ABN notice must communicate to patients
- How CMS frames reasonable cost estimate expectations
- Why payer-specific form variations may matter
Who Should Read This
- Emergency department administrators
- Urgent care and office-based practice leaders
- Medical coders and billers
- Revenue cycle staff
- Compliance and patient access teams
Codes Discussed
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