Advanced Beneficiary Notification (ABN)
Advanced Beneficiary Notification has been part of the Medicare program for many years. However, on July 31,2002 the Centers for Medicare and Medicaid Services (CMS) issued more stringent regulations on the use of ABNs.
An Advanced Beneficiary Notification is a written notice given by a healthcare provider to a Medicare beneficiary advising him or her that Medicare may not pay for a service and that the beneficiary will be responsible for payment. Frequently, these include services for which Medicare usually pays, but under specific circumstances - such as screening tests - Medicare will not pay the provider.
The intent of the ABN document is to provide the beneficiary with sufficient information to make an informed consumer decision about proceeding with the healthcare service if the beneficiary (or another insurance) will need to pay for the service.
If the provider fails to provide an ABN prior to rendering the service, the provider is then also unable to bill the Medicare beneficiary for the service.
How can Adler Advisory Services help your organization with the more stringent requirements of the new ABN forms?
• Implementation of the new form:
• Form CMS-R-131
• ABN-G
• ABN-L
• HINN
• Staff training on:
• How to determine when a form is required
• Identification of Services Due to Medical Necessity
• Identification of Non-Covered Services Due to
• Medicare Benefit Limitations
• How to properly complete the form
• Reason that Medicare will not pay
• Description of Service
• Estimated Cost
• Understanding of Signature Requirements
• Limitation on Liability (LOL)
• Refund Requirements(RR)
• When not to provide an ABN
• Billing for Denial
• Proper Use of Modifiers
Adler Advisory Services is ready to assist your organization to attain compliance with the updated ABN regulations. Let us demonstrate how Adler Advisory Services can help you achieve ABN Compliance. For further information, call 323/878-2633 or email Joel Adler.
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