Last Modified: 11/1/2018 Location: FL, PR, USVI Business: Part A, Part B
Updates to CMS’ Beneficiary Notices Initiative (BNI) -- effective September 4, 2012
Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the fee-for-service (FFS) Medicare program. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers.
Note: Please refer to the Centers for Medicare & Medicaid Services’ (CMS) Beneficiary Notices Initiative page for a complete listing of acceptable beneficiary notices and their associated instructions.
Advance beneficiary notice (ABN)
The advance beneficiary notice (ABN) is an Office of Management and Budget (OMB) approved written notice issued by providers and suppliers for items and services provided under Medicare Part B, including hospital outpatient services, and certain care provided under Part A (hospice and religious non-medical healthcare institutes only [RNHCI]). Skilled nursing facilities (SNF) should issue the ABN for Part B services only.
Note: The ABN should be given to beneficiaries enrolled in the Medicare FFS program. It should not be used for items or services provided under the Medicare Advantage (MA) Program or for prescription drugs provided under the Medicare Prescription Drug Program (Part D). The ABN is used to fulfill both mandatory and voluntary notice functions.
• The current version of the ABN is available through the Centers for Medicare & Medicaid Services (CMS) website: Advance Beneficiary Notice of Noncoverage (ABN) form (CMS-R-131) . This form also replaces the following notices:
• Notice of Exclusion of Medicare Benefits (NEMB)
• The ABN must be given by providers/suppliers of:
• Items and services provided under Medicare Part B, including hospital outpatient services, and SNFs services
• Items and services provided under Medicare Part A by hospice and religious non-medical healthcare institutes
• The ABN must be given to beneficiaries enrolled under the Medicare FFS program when one of the following conditions is met:
• Prior to providing an item or service that is usually paid for by Medicare under Part B (or under Part A for hospice and RNHCI providers only) but may not be paid for in this particular case because it is not considered medically reasonable and necessary
• Prior to providing custodial care
• Prior to caring for a patient who is not terminally ill (hospice providers only)
Note: The provision of the ABN is optional prior to providing an item or service that is never covered by Medicare (not a Medicare benefit).
Updates to manual instructions for ABNs (effective September 4, 2012)
For additional guidance regarding the use of the ABN and key updates (effective September 4, 2012) to Chapter 30 of the “Medicare Claims Processing Manual,” please refer to MLN MattersŪ article MM7821 and change request (CR) 7821 .
Source: CR 7821
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