Don't expect major changes, but you are required to switch. You should be used to the combined Advance Beneficiary Notification (ABN)/ Notice of Exclusion of Medicare Benefits (NEMB) form implemented last year. But did you know it's time again to upgrade to a newer version? 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, because 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 ABN, keep these ABN essential truths in mind so you don't run afoul of CMS's coding rules. 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."