New form doesn't include major changes, but you must make the switch. It may seem like just yesterday that you transitioned to the latest version of the Advance Beneficiary Notice (ABN), but it's actually time again to upgrade to a newer version of the form. The latest version of the ABN form CMS-R-193, with the release date of March 20, 2011, is now available at www.cms.gov/BNI by clicking the "revised ABN" link, said CMS's Donna Williamson during a June 28 CMS Open Door Forum. Although the form doesn't include any substantial changes, mandatory use of the new version begins on Nov. 1, 2011. A caller to the forum asked why the form was updated in the absence of substantial changes, noting many practices find it cumbersome and expensive to switch over to new forms. CMS's Stewart Streimer replied that the current ABN form had an expiration date on it, and forms are customarily updated every three years based on provider comments. Know These Key ABN Facts As your practice prepares to switch over to the updated form, keep these ABN essential truths in mind so you don't run afoul of CMS's coding rules. Background: ABNs let the patient know that Medicare may not cover a service, and that the patient will be responsible for payment if the claim is denied. Consequently, ABNs help patients decide whether they want to proceed with a service even though they might have to pay for it. A signed ABN ensures that the physician will receive payment directly from the patient if Medicare refuses to pay. Without a valid ABN, you cannot hold a Medicare patient responsible for the denied charges. For example: That's where the ABN comes into play. Avoid "routine" ABNs: Know when forms are considered "voluntary": Deliver the ABN properly: Know how to complete the "estimated cost" field: You may not be able to predict the exact amount that the service will cost, but you must make a "good faith effort to insert a reasonable estimate," which should be within $100 or 25 percent of the actual costs, whichever is greater. For example, CMS notes, if you expect the estimated cost for a service to be about $250, you can enter "Between $150 - $300" or "No more than $500" on the form. In addition, CMS notes, multiple services or items that are routinely grouped "can be bundled into a single cost estimate."