TAKE NOTE: New Medicare ABN Form Required
Written by Editor   
Sunday, April 16, 2017 12:29 PM

Take note that the government has issued new ABN forms.  Nothing has really changed on the form but the expiration date, but you must use the new form effective June 21, 2017.

Throw out your old ABN forms and replace them with the newly issued government form that is good until 2020.  Nothing but the expiration date has changed, but old forms won’t be accepted.

An Advance Beneficiary Notice of Noncoverage (ABN) is a written notice that a DC must give to a Medicare patient before CMT services are provided when the doctor believes that the services will likely be denied by Medicare.  The ABN, Form CMS-R-131, is issued by providers, physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50.

The current version of the ABN, a form considered by CMS to be an Office of Management and Budget (OMB) form, must be replaced every three years. In March 2017, the ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. While there are no changes to the form itself, providers should take note of the newly incorporated expiration date of 2020.  The effective date for use of this ABN form is 6/21/2017.

A non-substantive change has been made to the ABN, and in accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed.  

Download the current ABN

First Things First
Under Medicare, the only covered service for doctors of chiropractic is manual manipulation of the spine to correct a subluxation (CPT codes 98940, 98941, 98942). Only active treatment care (acute and chronic) is payable. 

Maintenance care is not payable, although it is still spinal manipulation and therefore normally a covered service. Knowing that you can have a covered service which isn’t payable is a very important point to understand for beneficiary notification purposes.

When to Use the ABN:

  • It's Normally a Covered Service, But It Isn't Payable Because It’s Not Medically Necessary

If you have reason to believe the treatment of a Medicare beneficiary for a particular treatment date is maintenance care (i.e. a treatment that Medicare would consider not reasonable and necessary and therefore not payable), you would have the beneficiary sign an ABN prior to providing care. The ABN is the form that is used when a normally covered service (such as spinal manipulation) will be denied due to lack of medical necessity. Using the ABN in this manner is mandatory if payment is collected for the service.

  • The ABN May Also Be Used for Non-Covered Services

The ABN may also be used for non-covered services (anything that is NOT spinal CMT—CPT codes 98940, 98941, 98942). This includes exams, modalities, x-rays, labs, etc. Using the ABN in this manner is purely voluntary.

Key Points

  • When notifying the beneficiary, you must use the current version of the ABN developed by CMS.

  • "Blanket" ABNs are not permissible.

  • The ABN is date-of-service specific, meaning that you can't just have one signed every once in a while and be on target—you have to have a reasonable expectation that that particular visit is not payable. Once an ABN has been signed for the purpose of indicating maintenance therapy, that ABN is valid for that series of maintenance treatment, until there is an exacerbation or any provision of active care, for up to one year. Once there is an exacerbation or new active treatment, any maintenance care following would require a newly delivered ABN.

  • The proper delivery of an ABN is very formalized and detail-specific.

  • If the beneficiary chooses to select the "Option 2" box, indicating they wish Medicare not be billed, then you CAN NOT bill Medicare. Please note this is a decision to be made by the beneficiary; you should not influence their choice. 

  • Aside from the exception above, maintenance care MUST STILL BE FILED. Doctors must verbally review the form with patients prior to their signing.

  • A Spanish-language version is available.

Source:  https://www.cms.gov/MEDICARE/medicare-general-information/bni/abn.html