Advanced Beneficiary Notice (ABN)….New for 2023
The new Medicare Advanced Beneficiary Notice of Noncoverage (ABN) form is available for FREE from Center for Medicaid and Medicare Services (CMS). This notice informs the beneficiary that the service offered, even if medically indicated, Medicare is not likely to provide coverage in a specific case. This form is needed to discuss, sign and share a copy in order to transfer potential financial liability to the beneficiary. The notice must be given prior to providing the services.
In the scenario with medical nutrition therapy visits, this can happen when the beneficiary has used up all the MNT hours for that calendar year. Medicare does not cover more than 3 hours the first calendar year and 2 hours subsequent years, with the physician's MNT referral. Note the hours are per patient, not provider. For example, if a patient saw another Registered Dietitian 3 years ago for an initial, and you are a new RD for the patient, you will be subject to the 2-hour limit. The MNT benefit is specific for a time frame and number of hours for initial year and subsequent years unless additional referral requirements are met. The form is completed by the beneficiary and the provider or office representative. A downloadable, fillable word document is available from CMS. Large print and Spanish versions are also resourced. The version of the form is effective June 2023 through January 31st, 2026.
The ABN should be completed to include
an explanation why the services will likely NOT be covered by Medicare
an estimate of the cost of the service
a discussion and the fees must be offered in advance of the visit
a signature of the beneficiary and date
a copy provided to beneficiary and one filed in chart
The ABN tells the beneficiary with Medicare as the primary insurance that there are three choices on the form:
OPTION 1. I want the D. listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.
OPTION 2. I want the D. listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.
OPTION 3. I don’t want the D. listed above. I understand with this choice I am not responsible for payment, and I cannot appeal to see if Medicare would pay.
When it is known that a service frequency is not covered, it saves provider and beneficiary time to select '‘proceed with service and pay at that time”. Waiting for the denial, wastes valuable time as well as finances for both.
The ABN form is optional for uncovered MNT diagnoses such as cancer, unintended weight loss, cardiovascular disease, eating disorders, gastrointestinal disorders etc. as these are not currently recognized by Medicare for individual--MNT coverage. Only diabetes and chronic kidney disease (Stage 3-5, if not on dialysis; and up to 36 months post kidney transplant) are statutorily covered under Medicare Part B. The other diagnoses have not yet been added by the legislative process. It is best practice to verify benefits and clarify with your client what is or is not likely to be covered by the health plan including expected costs. Surprises are never welcome.
Remember if you know that the service will be denied, Medicare expects the provider to know that a service might not be covered or exceeded the benefit limit. If you bill, you must indicate with a modifier that you expect the service to be denied. Otherwise, Medicare assumes you are fraudulently billing.
INSTRUCTIONS: https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-form-instructions.pdf
FORMS: 2026 ABN-Eng/Span/Large/reg print https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-forms-english-and-spanish-incl-large-print.zip
For commercial insurances, check their policy to see if they require and have their own Non-Covered Services form.
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Blog coming soon: Options to increase the covered Medicare MNT visits in a calendar year.