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CMS sets 8/31 deadline for new ABN, instructions

Get ready to update your Advance Beneficiary Notice of non-coverage (ABN) forms. Medicare has released a new form and instructions that will be mandatory on Aug. 31. The new forms have a 06/30/2023 expiration date in the footer and your practice may use them now.

Practices should also prepare for the new guidelines that will apply when an ABN must be issued to patients who are enrolled in Medicare and Medicaid (dually eligible patients).
“Dually Eligible beneficiaries must be instructed to check Option Box 1 on the ABN in order for a claim to be submitted for Medicare adjudication,” the instructions state.
In addition, you must make the following cross outs to the text of Option 1:
□ OPTION 1. I want the (D) listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.
The edits are necessary “because the provider cannot bill the dual eligible beneficiary when the ABN is furnished. Providers must refrain from billing the beneficiary pending adjudication by both Medicare and Medicaid in light of federal law affecting coverage and billing of dual eligible beneficiaries,” the instructions state.
The regularly scheduled update to the ABN is a good reminder to review some of the rules that apply to the form:
  • Forms must be printed on a single, one-sided page.
  • Forms may be printed on letter (8.5” x 11”) or legal-sized (8.5” x 14”) paper.
  • Printed or hand-written entries should be in 12-point font when possible, but 10-point is permissible if “detailed information must be given and is otherwise difficult to fit in the allowed space,” the instructions state.
  • Do not put an identifying number such as the patient’s Social Security Number or Medicare Beneficiary Identifier on the form.
  • Practices may fill in some portions of the form in advance, but it should not pre-select an option in section G of the form.
Blog Tags: CMS
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