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Linda Collins Blogger

ABNs Again

Posted by Linda Collins | September 12, 2012

CMS put into effect revisions to the Advanced Beneficiary Notification (ABN) manual this week. These changes bring the ABN into compliance with requirements arising out of the health care reform law (the Affordable Care Act). The changes clarify the use of the ABN in (1) new preventative services, (2) the DMEPOS competitive bidding program and (3) when upgraded components are added to a device.

ABNs are issued by providers and suppliers to inform Medicare beneficiaries about possible charges for items or services that are not covered by Medicare. The ABN serves as a notice to the beneficiary of impending financial obligation. The use of an ABN is mandatory when:

  • A non-contracted supplier provides a beneficiary with an item or service listed in the Competitive Bidding Program.
    Example: A patient has been referred to your practice for numerous DME items, including a standard walker. You are not a contracted supplier for walkers under the Competitive Bidding Program. You must provide the patient with an ABN and the option to obtain the item from a contracted supplier.

  • Prior to providing a service that is usually covered by Medicare but will not be covered because frequency limitations have been exceeded.
    Example: A patient received a prefabricated, elastic knee brace (L1810) six months ago and now wants a new brace since the first one has been worn a lot. The reasonable useful lifetime for this brace is defined as one year. You are required to provide the patient with an ABN.

  • When a beneficiary receives a Medicare covered item containing upgrade components that are not medically reasonable and necessary and not paid for by the supplier.
    Example: The patient has received a pre-fabricated, rigid knee brace (L1832) and is requesting an extra, removable soft interface (K0672) to wear with the brace. The patient will need to sign an ABN with explanation that the interface will be his/her financial responsibility.

A supplier does not have to use an ABN when the service provided is statutorily excluded from coverage by Medicare. However, in this situation, you may wish to issue the ABN voluntarily.

It is your responsibility to make sure your staff is aware of the requirements for the use of an ABN. More information can be obtained at

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