Situation Report | August 2, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has posted revisions to the Advance Beneficiary Notice of Non-coverage (ABN) section of the Medicare Claims Processing Manual.
The revised manual and a MLN Matters article are here.
Some of the key revisions include:
- General notice preparation requirements for the ABN.
- Events that cause home health agencies and hospices to issue ABNs and when they are not issued.
- Optional uses of the ABN.
- ABN delivery and retention.
- Period of effectiveness of the ABN for repetitive or continuous non-covered care.
- How the Financial Liability Protections apply to dually eligible individuals (Qualified Medicare Beneficiary Program or Medicaid coverage).
Medicare requires a health care provider or supplier to notify a beneficiary in advance of furnishing an item or service when he or she believes that items or services will likely be denied by Medicare for any of the reasons specified in the law in order to shift financial liability to the beneficiary for the denial. For example, advance notice is required if: the item or service may be denied as not reasonable and necessary; the item or service constitutes custodial care; the beneficiary is not “homebound”; or the beneficiary does not need skilled care on an intermittent basis.
ABNs apply at the beginning of a new patient encounter, plan of care or beginning of treatment; reductions of services; and termination of services.
Current ABN forms and instructions are at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.