NEW Mandatory ABN Form to Take Effect June 21, 2017

NEW Mandatory ABN Form to Take Effect June 21, 2017

The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form.  The revised Advanced Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The revised ABN replaces the ABN Form that was last released in November 2011.

When a physician or supplier has a “genuine doubt” that a service will be covered, he or she is required to notify the patient of this fact.  The ABN form is required to be used for a service that is covered under Medicare.  In the Medicare program, chiropractic coverage is limited to coverage for spinal manipulation by means of the hands or hand-held device.  For all non-covered services, a standard letter (as opposed to an ABN form) informing the patient of the non-coverage, or the ABN may be used. 

The newly revised ABN form may be used at this time; however, its use becomes mandatory on June 21, 2017.

The newest version of the ABN and the instructions for use can be accessed at

https://www.cms.gov/medicare/medicare-general-information/bni/abn.html

The primary difference found in the newest version of the ABN form is the statement of nondiscrimination practices.  While there are no changes to the form itself, providers should be able to discern between the old version and the new version by checking the expiration date on the form.  The new expiration date on the ABN form is 03/2020.  Significantly, a new alteration in wording has been made to the ABN.  In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format, if needed.

The new ABN form informs the reader that, “CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call 1-800-MEDICARE or email: AltFormatRequest@cms.hhs.gov.”

Liability for Payment

In view of the population diversity in the United States, the government is attempting to make the ABN understandable to all of the population.  It is important for the provider to inform the patient that, in the provider’s opinion, the services listed on the form are not expected to be covered by Medicare.  Since the services are not expected to be covered by Medicare, the liability for payment is now shifted to the patient.  Keep in mind that the form must be completely filled out, the reasoning for the expected denial must be listed on the ABN, and the cost must be listed.  Once the form is filled out, the patient must personally sign and date the form.  A copy of the completed form is then given to the patient.

The ABN form is actually a method for the provider to inform patients of their liability for payment.  It is only to be issued when there is genuine doubt that Medicare is going to pay for a service.  In chiropractic, since the only service covered is spinal manipulation, the ABN form is mandatory only for spinal manipulation.  One ABN form may cover a series of spinal manipulations that are not covered, but the form is not to exceed one year in length.

Again, keep in mind that the instructions for the use of the ABN form have not changed, but the wording has changed to reflect that the form is now available in several languages.  For a complete instruction manual on the ABN form, it is advised that you read the publication available at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Form-Instructions.pdf

About the Author

Dr. Mario Fucinari is a member of the Carrier Advisory Committee for Medicare.  He is a frequent speaker available through NCMIC, Foot Levelers and several state associations.  Dr. Fucinari is the author of several books, and training DVDs available at www.Askmario.com  You may contact Dr. Fucinari at Doc@Askmario.com

About Author

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

Dr. Mario Fucinari has helped train doctors and staff over the last 20 years. He received his bachelor's degree from Wayne State University in Detroit and his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1986. Dr. Fucinari was the recipient of the 1998 and the 2003 President's Award from the Illinois Chiropractic Society (ICS) for his work with education and training and most recently received the 2012 Chiropractor of the Year award from the ICS.

Dr. Fucinari was the first chiropractic physician to attain the Certified Medical Compliance degree. Two years later he earned his degree as a Certified Instructor for the Certified Medical Compliance Program. He is now the Chairman of the Chiropractic division of the national medical compliance program. He has produced classes and publications on HIPAA, Clinical Documentation, Medicare, and Stroke and Cervical Manipulation. He is a worldwide speaker for NCMIC, Foot Levelers, ChiroHealthUSA and several state associations and a Certified Chiropractic Sports Physician [CCSP].


Connect

Leave a reply

Recent Videos

Loading...

Corporate Club

Slider

Article Categories