Medicare to require updated notice of noncoverage form

Family physicians occasionally provide services to Medicare patients for which they expect they will be denied reimbursement because they do not meet Medicare coverage rules. In those instances, they may inform their patients of the situation with a form called an Advance Beneficiary Notice of Noncoverage (ABN). The ABN allows the patient to make an informed decision about whether to still receive the service, knowing that he or she may have to pay for it out of pocket.  

In March, the federal Office of Management and Budget renewed the ABN (Form CMS-R-131) and its instructions for another three years. The new forms are largely unchanged, except for the new expiration date of March 2020 and new language informing beneficiaries of their rights under Centers for Medicare & Medicaid Services (CMS) nondiscrimination practices and how to request the ABN in an alternative format. Physicians will need to use the updated ABN form beginning June 21, although you can begin using it immediately if you wish.

CMS has published guidelines for mandatory and voluntary use of the ABN in the Medicare Claims Processing Manual, Chapter 30, Section 50. The revised form and additional information is available on the CMS Beneficiary Notices Initiative webpage.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians