Managing ABNs just got a little easier.
According to revised guidance in the Medicare Claims Processing Manual, CMS is doing away with the requirement to renew the notices annually. Instead, notifiers can give beneficiaries a single ABN that describes an extended or repetitive course of non-covered treatment.
Extended ABNs are particularly relevant to:
Under the new guidelines, the extended ABN must:
The following example demonstrates valid ABN requirements, including sample language to document the period of effectiveness (in red):
According to revised guidance in the Medicare Claims Processing Manual, CMS is doing away with the requirement to renew the notices annually. Instead, notifiers can give beneficiaries a single ABN that describes an extended or repetitive course of non-covered treatment.
Extended ABNs are particularly relevant to:
- Continuous rental items like ventilators.
- Capped rental items that bill for 13 months (and sometimes longer after hospital admissions).
- Recurring supplies for lifetime conditions.
Under the new guidelines, the extended ABN must:
- List all items and services.
- Communicate the reason to expect a medical necessity denial in terms the beneficiary can understand.
- Specify the duration of the period of treatment.
The following example demonstrates valid ABN requirements, including sample language to document the period of effectiveness (in red):
Suppliers must secure new extended ABNs if there is any change in:
- Care from that described on the original ABN.
- Beneficiary health status.
- Medicare coverage guidelines for listed items or services.
While suppliers still need to monitor patients for circumstantial changes over an extended course of service, the new procedure is a welcome one expected to reduce the overall burden on suppliers.
SOURCE LINKS
https://www.cms.gov/files/document/mm12242.pdf
https://www.cms.gov/files/document/r10862CP.pdf
https://www.cms.gov/files/document/r10862cp.pdf#page=9
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