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Urology Coding Alert

Reader Question:

Find New ABN Forms on the CMS Web Site

Published on Fri Sep 07, 2007

Question: I've read that there's a new ABN form, but I can't find it anywhere. Where should I look?

South Carolina Subscriber


Answer: There are actually three new versions of an advance beneficiary notice (ABN) form now. You can find all three by going to www.cms.hhs.gov/PaperworkReductionActof1995. Click on PRA Listing on the left side of the page. Then search for "CMS-R-131" on the search page. This will take you to a page from which you can download the new ABN information, including a summary of the changes and the new forms.

The three versions of the form include a generic form that you can customize to the types of services you provide, a form using the term "items or services," and a form that uses the term "laboratory tests" and other customizations illustrating laboratory-specific use.

There are two main reasons to obtain a signed ABN from patients:

  • to ensure reimbursement for services provided but deemed not covered by Medicare, and
  • to reduce the risk of compliance implications associated with ABNs.

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, leaving the bill in the physician's lap.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.

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