Corporate Compliance

New guidance on ABNs

Medicare Insider, September 9, 2008

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The big news this week is the release of Change Request 6136. CR 6136 is the long awaited transmittal updating Chapter 30 of the Medicare Claims Processing Manual.  Chapter 30 provides guidance on the various Medicare regulations relating to beneficiary financial liability protections, including the so-called “limitation on liability” protections and the Advance Beneficiary Notice of Noncoverage, or “ABN.”[1]  

The transmittal is significant for at least two reasons. First, it formalizes CMS’ decision (as discussed in the August 26 issue of Medicare Weekly Update) to push the implementation date of the new ABN form back to March 1, 2009. It had been September 1, 2008.

Second, the transmittal revises Section 50 (the limitation on liability section) of Chapter 30 to provide new instructions on the use of the ABN form. These new instructions are important because the revised version of the ABN form is significantly different from the prior version. The new instructions in Section 50 are much more detailed than the informal instructions that CMS had previously released with the new ABN form (the transmittal includes 39 pages of revised manual instructions).

Between now and March 1, hospitals will need to closely study the new instructions and modify their operational procedures and systems to comply with the new instructions.

[1] CMS has changed the name of the ABN form from “Advance Beneficiary Notice” to “Advance Beneficiary Notice of Noncoverage.” However, CMS still refers to the form as the “ABN.”

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