Revised ABN and Non-Participating Providers

by  Wyn Staheli, Director of Content - innoviHealth
Dec 4th, 2017

Effective June 21, 2017, providers need to be using the new ABN form. Be sure that new ABNs are properly delivered for any Medicare patients seen since June 21st.

Non-participating providers need to note some specific instructional additions to the ABN which states the following (highlight emphasis added):

Special guidance ONLY for non-participating suppliers and providers (those who don’t accept Medicare assignment):

Strike the last sentence in the Option 1 paragraph with a single line so that it appears like this: If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.

This single line strike can be included on ABNs printed specifically for issuance when unassigned items and services are furnished. Alternatively, the line can be hand-penned on an already printed ABN.

The sentence must be stricken and can’t be entirely concealed or deleted.

There is no CMS requirement for suppliers or the beneficiary to place initials next to the stricken sentence or date the annotations when the notifier makes the changes to the ABN before issuing the notice to the beneficiary.

When this sentence is stricken, the supplier shall include the following CMS-approved unassigned claim statement in the (H) Additional Information section.

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

o This statement can be included on ABNs printed for unassigned items and services, or it can be handwritten in a legible 10 point or larger font.

• An ABN with the Option 1 sentence stricken must contain the CMS-approved unassigned claim statement as written above to be considered a valid notice. Similarly, when the unassigned claim statement is included in the “Additional Information” section, the last sentence in Option 1 should be stricken.

From these official instructions, it is not entirely clear if it is mandatory for all non-par providers to cross of text in Option 1. However, because there are special instructions, we recommend that these new guidelines be followed on all unassigned claims.

There are a few things to note:

1. Do NOT use white-out to cover up the words. Do NOT delete them in any manner. They must be visible as strikeout text.
2. Unlike many other legal documents, do NOT have staff or the patient initial the strikeout text.
3. Use the exact official text (highlighted above) in "Section H - Additional Information."
4. It is acceptable to have pre-printed forms with all the required revisions.