APMA News - July/August 2020 - 36

Reimbursement
By Barbara Aung, DPM, and Sarah Abshier, DPM

Advance Beneficiary Notice of Noncoverage:
What You Need to Know
An Advance Beneficiary Notice of Noncoverage (ABN) is a
waiver of liability. According to the ABN handbook, a resource available on the CMS website, "All health-care providers and suppliers must deliver an Advance Beneficiary Notice
of Noncoverage (ABN), Form CMS-R-131, when a Medicare
payment denial is expected in order to transfer financial liability to the beneficiary."
An advance written notice of noncoverage helps a Medicare
Fee-for-Service (FFS) beneficiary make an informed decision
about items and services Medicare usually covers but may not
pay because they are considered medically unnecessary.
The ABN must be reviewed with the patient and/or their
guardian, and any questions must be answered before it is
signed. It is required that the ABN be delivered to the patient
in advance so the patient has time to consider the options and
make an informed choice. HIPAA requires that a copy of the
ABN be retained in the medical record for six years unless
state laws require providers to keep medical records for a longer stated period (e.g., Arizona requires seven-year retention
of medical records).
The current ABN form may be downloaded from www.cms.
gov/Medicare/Medicare-General-Information/BNI/ABN.
html. The forms are available in English and Spanish, as well
as a large-print version. It is recommended that you download the ABN manual, along with all eight ABNs (available
both in PDF and Word formats). Please note CMS recently
released a new form with an expiration date of June 30, 2023,
which must be used starting August 31.
Common reasons for Medicare to deny an item or service
as not medically reasonable and necessary include:
* experimental and investigational or considered "research
only;"
* not indicated for diagnosis or treatment in this case;
* not considered safe and effective; and
* more than the number of services Medicare allows in a specific period for the corresponding diagnosis (frequency of
service or item).
Health-care providers are not required to notify the beneficiary before furnishing an item or service that is statutorily
never covered by Medicare, or that is not a Medicare benefit.
However, providers may want to consider providing an ABN
to alert the beneficiary to their financial liability. Provision of
this form will not affect the patient's financial liability, and the
beneficiary is not required to check an option box or sign and
date the notice.
36 APMA News July/August 2020

CMS does indicate that routine notice is prohibited. CMS
does not believe there is a need to issue an advance written
notice of noncoverage on a routine basis, with the following
exceptions:

http://www.cms.gov/medtcare/medtcare-general-information/bni/abn.html http://www.cms.gov/medtcare/medtcare-general-information/bni/abn.html http://www.cms.gov/medtcare/medtcare-general-information/bni/abn.html

APMA News - July/August 2020

Table of Contents for the Digital Edition of APMA News - July/August 2020