Pathology/Lab Coding Alert

Question: I’m new to our lab, but I noticed that the ABN form we’re using is different from what I was familiar with at my last job. How can I find out if we’re using a current, approved form?

Codify Subscriber

Answer: The correct Advance Beneficiary Notice of Noncoverage (ABN) form for use on and after April 4, 2023, is CMS-R-131 (Exp. 01/31/2026).

The Centers for Medicare & Medicaid Services (CMS) now offers additional guidelines for patients covered by both Medicare and Medicaid, known as dual-eligible beneficiaries. These patients cannot be charged for Medicare cost-sharing when they receive services under Medicare Part A or Part B.

ABN form defined: An ABN form is a written notification indicating that Medicare may refuse to cover or reimburse for services or items recommended by your doctor, healthcare provider, or supplier. Use the ABN to inform the patient in advance about their potential financial responsibility for the services or items in question. By signing the ABN, the patient acknowledges their understanding that they may be responsible for payment if Medicare denies coverage. The ABN also ensures transparency and allows patients to make informed decisions regarding their healthcare and associated costs before treatment.

Remember: When you believe a service may not be covered, such as a screening Pap test that exceeds frequency limits, you must provide the patient with a copy of the signed ABN, and you should keep the original ABN on file.

To access the new ABN form and the latest instructions, visit www.cms.gov/Medicare/Medicare-General-Information/ BNI/ABN.