The Centers for Medicare and Medicaid Services (CMS) has issued a revised advance beneficiary notice (ABN) form. The new form has an expiration date of 1-31-26 and will be mandatory on 6-30-23. You may continue to use the ABN form with the expiration date of 6-30-23 until the renewed form (expiration date 1-31-26) becomes mandatory.
The ABN is a document given to a Medicare beneficiary (one who is in the regular Medicare program, and not a Medicare Advantage plan) when the provider believes that Medicare is not likely to cover a service. It is a service-specific document and not a blanket, sign-it-once document as part of the new patient packet. The types of providers required to provide the beneficiary with an ABN include: physicians; hospitals; providers and suppliers paid under Part B, including laboratories; hospices; home health agencies, and a few less common provider types.
The purpose of an ABN is to transfer potential financial liability to the beneficiary. Basically, let’s say you believe your patient needs service A – or your patient wants service A – but you’re doubtful that CMS will cover it. Maybe the patient doesn’t meet the criteria to receive the service or it’s not a covered service but the patient wants it anyway. Prior to delivering the service, the provider explains all of this to the patient, including the fact that Medicare may not pay for it, and provides the patient with a completed ABN. This puts the patient on notice – and he or she essentially agrees – that if CMS declines payment of the service, the patient will be responsible for paying.
A few caveats:
- All of the patient’s questions must be answered by the provider before the patient signs the ABN; this is not one of those perfunctory “Just sign here” situations.
- The ABN must be provided far enough in advance so the beneficiary has time to consider his/her options and make an informed decision. ABNs are never required in emergency or urgent care situations.
- The completed ABN form can have no blank spaces.
- Once the form is complete, the beneficiary will sign the form and receive a copy. The provider must retain a copy of the signed ABN in the file.
An ABN may also be used to provide notification of financial liability for items or services that Medicare never covers. In that case, it is not necessary for the beneficiary to choose an option box or even sign the notice.
The revised ABN form in English and Spanish can be downloaded here. The ABN instructions document can be downloaded here.