Corporate Compliance

Note from Hugh

Medicare Insider, March 11, 2008

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Every three years CMS updates the Advanced Beneficiary Notice (ABN) for outpatient medical necessity. CMS announced on March 3, 2008 that the form had been renamed the "Advance Beneficiary Notice of Noncoverage" to more clearly convey the purpose of the notice. You can find a link to the new form in the "Other CMS and OIG issuances" section below.

The notice has not changed in intent or purpose from the old ABN. The new ABN is multipurpose, with one form replacing three old forms, including R-131G, R-131-L, and the voluntary Notice of Exclusion from Medicare Benefits (NEMB). Note that use of the new ABN form is still voluntary in situations in which an NEMB form was used previously, but providers do not need to maintain a separate form.

Other new features of the form are that a facility or provider must provide cost estimates. Previously these were not a mandatory requirement. The new form can be used for laboratory services as well.

The new ABN form is effective March 3, 2008, and all providers and facilities must begin using the form no later than September 1, 2008. Facilities will require training on the specifics of these changes and should target areas customarily responsible for the ABN process, such as registration/admitting services and clinical departments. Additionally, you should contact your information services department to ensure that the new form is loaded into the appropriate software, and if a logo or identifying provider/facility information is printed on the form it complies with the font requirements.

~ William Malm, ND, RN

Editor's Note: William Malm, practice director of Revenue Cycle Management for HCPro, is the author of this week's "Note from Hugh" in Mr. Aaron's absence.

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