Time to update ABN Forms

We would like to inform you that it is time to replace your current ABN forms for Medicare Patients: 2017
You are required to switch to the new advance beneficiary notice of non-coverage (ABN) and this might be a good time to review the guidelines for the use of the ABN form with your administrative and clinical staff
The following changes were made:

  • CMS has added language that informs your patients that CMS doesn’t discriminate
  • ABN in an alternate formats, such as large print, in accordance with section 504 of the Rehabilitation Act of 1973 is available

There are no changes to the way practices complete the ABN, but they must start using the new form by June 21, 2017
Please find following suggestions with regard to the new ABN you might want to share with your staff:

  • Check the expiration date. After June 21, the expiration date in the lower left corner should be 03/2020.
  • Use ABNs for traditional Medicare Part A and Part B patients. Private payers and Medicare Advantage have their own forms similar to the ABN, but they are not interchangeable. United Healthcare and Empire Blue Cross forms are available for download on our website. Please click here to access the files. You may also find the ABN forms located on your payer’s website. It is important to utilize the ABNs for your specialty as certain lab tests are exclusive to specific labs, e.g. Vectra , Avise, SLE-key
  • Give patients an ABN when Medicare would usually cover the service they will receive, but you know or believe it will be denied for the specific patient, e.g. if the service will exceed Medicare’s frequency limits.
  • We suggest you review LCD (local coverage determinations) quarterly to make sure you are aware of changes to frequency, covered diagnoses, and other requirements that may trigger the need for an ABN.
  • Write the reason Medicare may not pay in Section E in a way the patient can understand. The reason must be patient-specific.
  • Provide contact information for your billing office in Section H if it is different from the practice’s information in Section A.
  • Never select an option in Section G or tell the patient which one to select. However, you may discuss the different options with the patient.

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