Otolaryngology Coding Alert

HCFA has released a draft version of a new advance beneficiary notice (ABN) form designed to be more readable and easier to understand.

Simplifying the ABN was among the top-five priority issues recently identified by doctors for HCFA to address.

ABNs are used by physicians and medical-equipment suppliers to notify Medicare patients that Medicare probably will not pay for a service or item. If the patient still wants the service, an ABN must be signed to indicate that the patient is aware that he or she will have to bear the cost.

The revised ABN specifies:

Medicare does not pay for all of your health care costs. Medicare only pays for covered items and services when Medicare rules are met. The fact that Medicare may not pay for a particular item or service does not mean that you should not receive it. There may be a good reason your doctor recommended it. Right now, in your case, Medicare probably will not pay for the item or service.

The ABN also advises the beneficiary to ask for a further explanation if he or she is unsure why Medicare probably will not pay, and to check how much the item or service will cost either out-of-pocket or through other insurance. The patient is then asked to check one of two options, and sign and date the form.

The first option reads, Yes, I want to receive these items or services. The second option reads, No, I have decided not to receive these items or services.

Note: The draft, single-page ABN can be downloaded for viewing at www.hcfa.gov/regs/prdact95.htm. Click the link just below the heading April 19, 2001 Information Collection Requirements in HCFA-R-131.