CMS Asks for Comment on the ABN–Again

WASHINGTON–A notice published in the May 25 Federal
Register announced the start of a second public comment period
on additional revisions to the Advanced Beneficiary Notice.

CMS said the new ABN package reflects changes made after the
first round of public comments about its February proposal to
combine two versions of the form–a general and a
laboratory-specific–into a single notice. ABNs are used to warn
beneficiaries before a procedure or service that Medicare likely
would not cover it, giving them the opportunity to forgo the
service or to assume the financial responsibility themselves.

CMS said in the notice that it expected compliance with ABN
requirements would involve more than 4.7 million hours and more
than 1.2 million respondents annually, with a total of more than 40
million responses.

The proposed changes to the ABN include:

–Replacing the term “items/services” with a customizable blank
so that users can insert a description most appropriate to their
specific businesses.

–Streamlining text as much as possible to include more
“beneficiary-friendly plain language.”

–Replacing the label “supplier/provider” with the more generic
“notifier,” since this term captures disparate groups such as
physicians, practitioners and various provider and supplier
types.

–Changing the label “beneficiary name” back to “patient name”
in response to comments that the simpler language in the current
ABN be maintained. (CMS said it had proposed the change to
“beneficiary” to make it clear that the notice is only required
from Medicare, which the agency said was a repeated point of
inquiries.)

–Shortening the paragraph above the items and service box to
clarify that Medicare does not pay for all services, even if
recommended by a health care provider.

–Re-ordering the options box so that the first option is the
one that makes beneficiaries aware of their right to receive
services and appeal to Medicare should they be denied.

–Wording would note that beneficiaries are still responsible
for payment if Medicare does not pay; provide information on the
Medicare Summary Notice as the vehicle informing beneficiaries of
official payment decisions and appeal rights; be adjusted so that
non-participating providers are less likely to have beneficiaries
seeking refunds from them inappropriately; and add information on
Medicare cost-sharing amounts that are not refundable when Medicare
pays.

–Replacing the label “other insurance” with “additional
information.” CMS said many commenters opposed the mandatory
inclusion of information about other insurance, since there is no
requirement that they bill such insurers.

–Adding 1-800-MEDICARE contact information.

–Removing the heading “Privacy Notice” from the disclosure
statement.

During the comment period, CMS said providers should continue
using the existing ABNs until a final combined notice is
approved.

To view the entire list of proposed ABN changes, go to http://www.cms.hhs.gov/PaperworkReductionActof1995,
click on PRA listing and scroll down to CMS-R-131.

Comments must be received by 5 p.m. on Sunday, June 24,
2007.