ABN – A Brand New Form

ABN – A Brand New Form

The wait is finally over.  You no longer need to feel like you are breaking the rules of Medicare by using an ABN form that expired in March 2020.  CMS was delayed in approving the new ABN form; however, on June 24th, they updated their website and released the latest version. The CMS website states: “The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020.” KMC University members will find all of the updated materials in the Library within the next week to ten days, and can concentrate on updating their internal forms and processes then.

Remember, the ABN form is not optional for spinal CMT services that no longer meet the definition of Medical Necessity as established with Medicare.  * “The ABN form is utilized to transfer potential financial liability to the beneficiary, and deliver the notice prior to providing the items or services that are subject of the notice.”  When properly utilizing the ABN form, the AT billing modifier can then be switched to a GA billing modifier, demonstrating that you have a valid, and signed ABN on file with the patient for this phase of maintenance care.

New Form—New Rules for QMB

“The ABN is a formal information collection subject to approval by the Executive Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (PRA). As part of this process, the notice is subject to public comment and re-approval every 3 years. With the latest PRA submission, a change has been made to the ABN. In accordance with Title 18 of the Social Security Act, guidelines for Dual Eligible beneficiaries have been added to the ABN form instructions.”

A Dual Eligible beneficiary, also known as Qualified Medicare Beneficiary (QMB), are those patients that fall below certain income thresholds. When a patient is marked as a QMB, it is essential to note that this is not a permanent status.  Due to the change in the CMS ABN form, the importance of proper verification has increased significantly. We recommend that you are checking monthly to determine the eligibility of the patient as a QMB.

CMS gives specific instructions regarding the completion of the ABN form.  We all know that you are not permitted to influence the decision of the Medicare patient in which option to select, but is that true.  For the most part, yes, but for the QMB patient, you must instruct the patient to choose Option 1.  In addition to instructing the QMB patient to select Option 1, additional edits must be made to the wording of contained in Option 1.

What About Voluntary?

Remember, it’s our recommendation that you do not use this official form for Voluntary purposes. You name it…we have heard it at KMC University.  For those services that are statutorily excluded, such as exams, x-rays, therapies, etc., you are best to utilize your office letterhead for this special notification.  Among the many reasons to do it this way:  you can have the form signed.

Clarification for Non-Par and Not Accepting Assignment

There has been discussion as to where the additional information was required in Box H for Non-Par/Not Accepting Assignment providers.  Thank goodness they thought to include the word “providers” this time and didn’t just leave it as supplier.  KMC University had previously reached out for guidance on this subject and had been informing our clients of the Box H requirement, but much was left to individual interpretation as to whether “supplier” included chiropractors or providers in general.  The answer was always yes, but the language is now included in the ABN instructions issued by CMS.

A Final Thought:

KMC University is known as the place to go for Medicare resources and training.  We have been keeping our ears and eyes peeled for the last six months waiting on a final determination from Medicare.  Everything we have been saying for years has been better laid out by CMS in the latest instruction form.

I am sure many of you are just like the people we talk to everyday…confused by the ABN form or may have been using the wrong form since June 21, 2017.  We understand, and we know how to help.   As I learned in my compliance training, you don’t have to know all of the answers, but you do need to know where to get the information.  This rings the same for you, you may not know all of the answers, but you can trust KMC University to be the resource you need for your practice. For just a $99 Solution Consultation (even less for KMC University members) a certified specialist will uncover your practice needs and areas of risk and provide a solution that is tailored to your situation.

Yvette Noel is the Director of Education and conference speaker with KMC University. She is a Certified Professional Compliance Officer (CPCO). She has served the chiropractic community for over 15 years and has worked in the medical field since 1988. Through this experience, she has continued to develop her skills of medical coding and billing. Before coming to KMC University, she managed a very successful Chiropractic and Occupational Health business. She remains very passionate about KMC University and takes much pleasure in helping members with their documentation, reimbursement, and compliance needs