The Centers for Medicare and Medicaid Services (CMS) has now published the final form and instructions for the new CMS-R-131 (ABN) form. 

The ABN is required as written notice to inform Medicare beneficiaries of their liability regarding non-covered services as outlined in Section 1879 of the Social Security Act (SSA).

The form(s) and updated instructions are posted on the Beneficiary Notice Initiative (BNI) web page at www.cms.hhs.gov\bni.

The original September 1, 2008 deadline for required use of the new ABN has been extended. According to the CMS website, providers and suppliers will not be required to use the new form until March 1, 2009.

On March 3, 2008, the Centers for Medicare and Medicaid Services (CMS) announced it had replaced both the General Use Advanced Beneficiary Notice (ABN) (CMS-R-131-G) and the Laboratory ABN (CMS-R-131-L) with a new “Advanced Beneficiary Notice of Noncoverage (ABN) (CMS-R-131).”

Previously there were two approved versions of the form, the General Use ABN-G (CMS-R-131-G), and a version specifically for laboratory tests; ABN-L (CMS-R-131-L).The new version of the ABN combines the ABN-G and the ABN-L into a single notice, with an identical OMB number. 

When CMS first announced the September 1^st deadline for required use of the new ABN, CLMA, as well as other laboratory associations, repeatedly asked CMS to extend the deadline. We asked CMS for an extension of the transition period to the new CMS-R-131 (ABN) form and instructions from six months to 12 months. We also asked that the transition period begin only once official final instructions were issued.

Highlights of the instructions include the following:

• The ABN must be verbally reviewed with the beneficiary or his/her representative, and any questions must be answered before the notice is signed. The signature indicates that the beneficiary has received the notice and understands its contents

• Although the new ABN combines the general ABN (ABN-G) and the laboratory ABN (ABN-L) into a single notice with an identical OMB form number, the new notice does permit pre-printing of the laboratory-specific reasons for noncoverage of previously included on the ABN-L:
  
  1) “Medicare does not pay for these tests for your condition”
  2) “Medicare does not pay for these tests as often as this (denied as too frequent)”
  3) Medicare does not pay for experimental or research use tests.

• CMS does provide alternate versions of the ABN, including one that illustrates the laboratory-specific use of the notice

• Although CMS has published instructions for completing the new form, once the approval process is completed, detailed instructions will be placed in the online Medicare Claims Processing Manual Publication 100-04, Chapter 30

• The body of the new form allows for multiple items or services to all be explained by one reason, or bundled under one cost, so that the same information does not need to be entered multiple times. An attached sheet is permitted if the number of items or services won’t fit onto the one-page ABN

• Instructions still state that notifiers must enter a cost estimate for Blank (F) for items and services listed on the form. Itemized costs may be totaled, but it is not required. The new ABN will not be considered valid unless there is a “good faith” attempt to estimate cost. CMS will be “flexible in defining what a good faith estimate is, particularly in the case the ordering and rendering providers may be different”

• There is additional space for providers to enter information that may be useful for beneficiaries, i.e., from the former ABN-L, “[You should] notify your doctor who orders these laboratory tests you did not receive them”