New ABN Form Now Available
Mandatory by November 1, 2011
By: Justin Vaughn, M.Div, CPC, Director of Compliance

8/15/2011

CMS has published a new Advanced Beneficiary Notice of Non-Coverage (ABN) meant to replace the current ABN-G (Form CMS-R-131G), dated 03/08, as well as ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).  The new ABN can be identified, in part, by the date designation “(03/11)” on the bottom left-hand corner of the form.  Either the current or the new form may be used through October 31 of this year.  However, beginning on November 1, the new form (03/11) will become the only ABN recognized by Medicare for most physician and laboratory services.

As you may know, Medicare requires that the provider submit to the beneficiary an ABN in situations where Medicare payment is expected to be denied.  The provider must go over the form with the patient, and ensure the form is completed and signed.  Many anesthesiologists rely on the surgeon to provide them with information pertinent to potential non-coverage of a particular procedure, along with the actual ABN form in such cases.  However, if you would like to learn more about the purpose and proper usage of these forms, you should review the instructions provided by CMS at http://www.cms.gov/BNI/02_ABN.asp#TopOfPage, where a copy of the new form may also be obtained.  Alternatively, you can contact the Medac compliance advisor for your group.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.