Centegra modifies new ABN form to best suit needs

Transition has been pretty routine’

Hospitals that have long designed and used their own advance beneficiary notices (ABN) to inform patients that a service is not likely to be covered by Medicare now should be using a form released by the Centers for Medicare & Medicaid Services (CMS).

Most access managers have longtime familiarity with the ABN, which is a written notice that is given to a Medicare beneficiary before services are provided when it is determined that Medicare probably won’t pay for the service. Beneficiaries then have an option to receive the service and assume responsibility for the charges if indeed Medicare does not pay, or to decide not to have the service.

Although making the transition to use the new form has been "pretty routine" for staff, there are some things that access managers should keep in mind, suggests Liz Kehrer, CHAM, system administrator for patient access at Centegra Health System in McHenry, IL.

The ABN (CMS-R-131-G) form, which hospitals were required to use on Oct. 1 of this year, can be used for all hospital services, including laboratory services, Kehrer notes, although there is another template (CMS-R-131-L) that specifically is for lab services. "We opted not to have two ABNs," she adds, "So we use the generic form for both purposes."

Except for attaching the hospital’s name or logo, she says, providers may modify the ABN form only within two sections near the top of the form. Copies may be downloaded at http://cms.hhs.gov/medicare/bni. Questions and answers regarding the use of the ABN form also are available, at http://cms.hhs.gov/medlearn/refabn.asp.

"What I did within those [two open sections] is to put the most common services for which ABNs are issued to Medicare beneficiaries at my facility and the most frequent reasons why we believe those services won’t be covered," Kehrer explains. "Depending on what they see in their areas, hospitals can fill in the boxes [accordingly]." 

There are small boxes to the left of each service or reason that may be checked, she adds, and a line at the bottom of each of the two sections where another service or reason may be added.

To be acceptable, according to Centegra’s training material developed from CMS releases, an ABN "must clearly identify the particular item or service, must state that the physician or supplier (hospital) is likely (or certain) to deny payment for the particular item or service, and must give the physician’s or supplier’s (hospital’s) reasons for its belief that Medicare is likely (or certain) to deny payment for the item or service."

The training material goes on to explain that the ABN must include a written explanation in "lay language." Simply stating "medically unnecessary" or the equivalent is not an acceptable reason, it says. "The ABN must give the beneficiary a reasonable idea of why the provider is predicting the likelihood of Medicare denial," the training document continues, and it states in bold-faced type that "a provider is prohibited from obtaining beneficiary signatures on blank ABNs and then completing the ABNs later."

Providers also are required to have forms available in Spanish, says Kehrer, who had both the services and reasons her facility includes translated into that language. Looking for ways to fill in the "other" line, if necessary, with the proper translation, she adds, Kehrer found an extremely helpful web site.

By going to www.freetranslation.com, she notes, access managers can have information translated not only into Spanish, but other languages as well. "You click on the tab for free translation, and you are asked from which language to which," Kehrer adds. "It’s listed as a global business site."