ABN Form

What is an ABN form? Formally known as an Advance Beneficiary Notice of Noncoverage, it is insurance, a safeguard, an agreement. Occasionally, Medicare will refuse to pay for a service that it usually covers, or will deem a procedure medically unnecessary or unreasonable. It is in these cases that the ABN form becomes invaluable.

According to the Centers for Medicare and Medicaid Services (CMS) ABN information booklet, when patients fill out an ABN form, it insures that they know, prior to service, that Medicare might not cover their procedures and that they accept full financial responsibility. 

Warning: "If you do not issue a valid ABN to the beneficiary when Medicare requires, you cannot bill the beneficiary for the service and you may be financially liable." (ABN Information Booklet)

There are some things to know about requiring patients to fill out ABN forms:

• An ABN form must be filled out and submitted before the medical procedure. 
• ABN forms may not be submitted if Medicare intends to pay for the procedure. 
• You must be enrolled as a Medicare supplier or provider to use the ABN.
• The ABN must be verbally reviewed with the beneficiary or his/her representative and any questions raised during that review must be answered before it is signed. 
• The ABN must be delivered far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice. 
• Employees or subcontractors of the notifier may deliver the ABN. 
• ABNs are never required in emergency or urgent care situations. 
• Once all blanks are completed and the form is signed, a copy is given to the beneficiary or representative. 
• In all cases, the notifier must retain the original notice on file.

To learn what types of procedures Medicare may not cover, consult the Medicare Coverage Database.

Simple steps to find the most recent ABN form (as of 06/10/2013):

1. Go to Medicare's website. 
2. Once you are on this site, click on FFS ABN in the left-hand selection column. 
3. Then scroll to the bottom of the page, and click the first downloads link: Revised ABN CMS-R-131 Form and Instructions.  This is a ZIP file, which will contain a folder with several different files from which you can select.
4. Choose the 508ABN.PDF and double click it to open it. Note: There is also a Spanish form in the list 508spanishabncorrected.pdf or docx.

You can also download the zip file directly.

What is the most surprising noncovered procedure your practice has dealt with? Let us know in the comments below.

Contributor: Kylie McKenzie Soder