Understanding the Medicare Advance Beneficiary Notice of Noncoverage (ABN)
Updated: Sep 29, 2022
Also known as form CMS-R-131, applying the ABN when needed might be among the most misunderstood areas for Medicare providers. The purpose of the ABN is:
If Medicare does not cover a service or treatment you have provided a patient, you can collect from the patient only if you have communicated the cost, that the cost will be their responsibility, and that the patient agreed to pay the cost as indicated by his/her signature on the form.
If you provide services Medicare does not routinely cover, you could be missing out on earned revenue if you do not use the ABN with Medicare patients.
Using the form is not intuitive. One reason for this is that the communications must be made, and the form must be completed and signed PRIOR to providing the treatment.
While you can use the ABN for Medicare Advantage Plans, it's the traditional Medicare (also known as the red, white, and blue card) that requires the ABN.
Even for a non-Medicare patient an ABN type work practice might be a good idea when a patient will be paying for the service out of pocket.
The latest ABN form has a date of 03/2020 in the lower left-hand corner. That's the one currently in use.
You are not required to use the ABN for services never covered also called statutory exclusions though you can obviously collect for these at the time of the service.
Services not covered by Medicare include: those not medically reasonable or necessary; statutory exclusions; services and supplies denied as bundled or included in another service, and items and services reimbursable by other organizations or performed / supplied without charge.
For comprehensive instructions on completing the ABN, you can visit this link.
Mastering this Medicare procedure could prevent a lot of revenue from being lost and upsetting patients after they receive a bill for a service they thought would be covered.