Patient Access Monthly Source: The Academy of Healthcare Revenue
Understanding the Revised Advance Beneficiary
Notice’s Impact on Patient Access Processes
Last spring, the Centers for Medicare and
Medicaid Services (CMS) updated the
Advance Beneficiary Notice (ABN) form
required for physicians and other providers
to use when beneficiaries’ services are
not expected to be covered by Medicare.
CMS allowed a 6-month transition period
from the date of implementation for use of
the revised form, meaning that all providers
must use the revised form by September
1st.1 Patient access staff must be aware
of this revised form and be prepared for its
impact on registration processes.
The new ABN form will replace the existing
ABN-G (General), ABN-L (Laboratory),
and NEMB (Notice of Exclusion from Medicare
Benefits) forms for voluntary notifications. One of the key changes in the
revised ABN is the new official title, the
“Advance Beneficiary Notice of Noncoverage
(ABN),” to more clearly state the purpose
of the notice. The revised version continues
to combine the general ABN and the
laboratory ABN into a single notice, with
an identical Executive Office of Management
and Budget form number. The revised
ABN includes a new option under which a
patient may choose to receive an item or
service and pay for it out-of-pocket, rather
than first submitting a claim to Medicare to
determine coverage.
In some cases, the presentation of an ABN
may be perceived negatively or as confusing
by some patients. Therefore, patent access
staff must know how the changes mentioned
above may affect how they provide
ABNs, enabling staff to effectively explain
the revised ABN. Patient access staff can
do the following to ensure patients understand
the revised ABN, and that it does not
negatively affect reimbursements:
Review Changes, Conditions. Patient
access staff must verbally review the
new ABN with patients and address any
questions they raise before the form is
signed. Patients who are unaware of
changes to the ABN may also potentially
be unaware of their financial options
and ABN terms. For example, a patient
may be unaware of the new option to
pay out-of-pocket on the revised ABN
form; therefore, staff must verbally
communicate this option to ensure the
patient knows of this change.
Verify Patient Information. If a patient
requires an ABN, patient access staff
must take the necessary steps to ensure
the patient’s data is correct in order to
avoid billing errors, such as a wrongly
indicated payment method. Also, how
the patient will be paying the amount
can and should be determined at the
time the ABN is issued.
Specify Reasons for Non-Coverage.
“Notifiers” (e.g., patient access staff
or clinicians) may need to explain in
patient-friendly terms why they believe
Medicare will not cover the service to
be rendered in order to comply with
the revised form. Staff must know the
correct way to specify this for patients if
they are unclear as to why their services
will not be covered by Medicare.
Estimate Costs. Staff must give a cost
estimate for the service in question
according to CMS guidelines, as the
revised ABN will not be considered
valid if there is no attempt to provide
an expected balance for patients. An
automated estimation system may
enhance the process by providing
patients with a quicker and more
accurate cost expectation.
In light of CMS’ revised ABN form, it is
important for patient access staff to educate
themselves concerning this and all
other types of regulatory updates pertaining
to their job responsibilities. Doing so
will help them to remain compliant with
applicable rules, increase patient satisfaction,
and provide a head start on obtaining
reimbursement for their hospitals.
1 “Beneficiary Notices Initiative,” The Centers for
Medicare and Medicaid Services, 3 March 2008.
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Media Contact Andrea Morrill
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