CAP@Your Service – April 2008

The Centers for Medicare and Medicaid Services (CMS) recently announced that all providers and suppliers can begin using the revised Advanced Beneficiary Notification form (CMS-R-131) and are required to do so no later than September 1, 2008. The revised ABN form is now titled, “Advance Beneficiary Notice of Noncoverage,” and replaces the existing forms: ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).

Some key features of the new form, include:

• New, official title, in order to more clearly convey the purpose of the notice
• Replacement of both the existing ABN-G and ABN-L forms
• Multiple uses—e.g. the form may also be used for voluntary notifications, in place of the Notice of Exclusion from Medicare Benefits (NEMB)
• Mandatory field for cost estimates of the items/services at issue
• New beneficiary option, under which an individual may choose to receive an item/service, and pay for it out-of-pocket, rather than have a claim submitted to Medicare.

The new form must be verbally reviewed with the beneficiary or her/his representative. Any questions raised during the review must be answered before the form is signed.

As March 3, 2008, the CMS will allow a six month transition period for all providers—including independent laboratories, physicians, practitioners, and suppliers—to use the revised form and instructions where Medicare payment is expected to be denied. Please note: Skilled Nursing Facilities can still use the ABN-G form until the SNFABN is released sometime between now and September 1, 2008.

For more information, visit the CMS Web site.