Recent Updates in Advance Beneficiary Notices

Question

Can you please tell me about recent changes in Advance Beneficiary Notices?

Answer

On March 3, 2008, Medicare released a new Advanced Beneficiary Notice (ABN) form. This form must be given to patients prior to delivery of services for situations when:

1. Medicare may deny payment for that specific procedure or treatment;
   
2. The patient would be personally responsible for all payment if Medicare denies payment.

In its statement of March 3rd, Medicare will permit a period of transition for six months from the old form to the new form. August 31st will be the last day to use the old form. This does not mean that one waits until September 1st to begin to use the new form, it simply allows time to deplete the supply of old forms before switching to the new form. The revised ABN form replaces the following forms: ABN-G, ABN-L, and NEMB.

Some of the key features of the new form include:

• A new official title (Advanced Beneficiary Notice of Noncoverage) to describe more appropriately the purpose of the form.
  
  
• This one new form replaces both versions of the old ABN forms
  
  
• The new ABN form may be used for voluntary notifications of non-coverage and replaces the old Notice of Exclusion from Medicare Benefits (NEMB).
  
  
• The new form has a mandatory field for cost estimates of the service, procedure, or item.
  
  
• The new form includes a beneficiary option under which an individual may choose to receive an item or service and pay for it out-of-pocket rather than have a claim submitted to Medicare.
  
  
• The ABN cannot be altered except as specified in the accompanying instructions.

The new ABN form and instructions can be accessed at www.cms.hhs.gov/bni.

Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the immediate Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.