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Understand how the new Advance Beneficiary Notice will affect patient access and clinical department staff members

HIM Connection, December 30, 2008

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On March 3, 2008, CMS released a new Advance Beneficiary Notice (ABN) of Noncoverage (ABN-R-131). The new form replaces the ABN-G and ABN-L and is used for all Part B provider and supplier services. The new ABN will not replace the skilled nursing facility ABN-G form that is currently under development.

CMS has given providers some leeway by offering an implementation period through February 28, 2009. During that time, hospitals may continue to use the old versions of the ABN. However, hospitals will be required to use the new ABN-R-131 as of March 1, 2009.

Patient access and clinical department staff members will be affected by the new ABN. Ensure that you train staff members on the specific requirements of the new form, including when it is voluntary or mandatory. Staff members may need training on how to look up a procedure in the chargemaster in the event that an ordering physician does not provide CPT codes. This will ensure that the correct item or service is listed in the Items and Services blank and the associated charge is listed in the Estimated Costs blank. Staff members should have a robust system for contacting the physician when there is a need to clarify the test or service to arrive at the most accurate CPT in the chargemaster.

Editor’s note: This article was adapted from HCPro’s white paper "Ensure that your hospital is ready to use the new ABN form" posted on the Revenue Cycle Institute’s Web page. To download this and a variety of other free white papers, click here.

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