Pulmonology Coding Alert

Question: Our office manager asked me to make sure we’re using the most up-to-date advanced beneficiary notice (ABN) form with our patients. I can’t remember the last time we received an updated form.

Where can I find the correct ABN form for our patients?

Oklahoma Subscriber

Answer: The correct form for use on and after April 4, 2023, is CMS-R-131 and it will expire on Jan. 31, 2026. The Centers for Medicare & Medicaid Services (CMS) now offers additional guidelines for patients who are 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. This form is used to inform the patient in advance about their potential financial responsibility for the services or items in question. By signing the ABN form, 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.

Don’t forget that 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, go to www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.