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Important News Regarding Advance Beneficiary Notice (ABN) and DME/Supplies Upgrades! The Center for Medicare and Medicaid Services has issued instructions for use of the new advanced beneficiary notice. We urge all members to review this important information.Information About ABN The ABN form, developed by the Center for Medical Services (CMS, formerly HCFA), is effective immediately and gives consumers freedom to choose the products that are best for them without paying the entire up-front cost of products not traditionally covered by Medicare. For reimbursement purposes, Medicare identifies which home medical equipment and supplies are "medically necessary". The definition of "medically necessary" usually applies to less advanced or "stripped-down" products. In the past if beneficiaries wanted to upgrade to a product that better met their clinical and personal needs, they were responsible for paying the whole up-front cost of the product and waiting for Medicare to reimburse them for 80% of the allowable fee. Under the new guidelines, however, beneficiaries can upgrade by paying the difference between Medicare reimbursement and the price of the equipment they prefer. This new process benefits Medicare recipients, and it enables DME providers to function within a realistic business model when offering their customers higher quality services. When a supplier believes that Medicare may not reimburse for some or all equipment and services provided, the supplier must have the beneficiary complete the ABN form. By completing the form, the beneficiary acknowledges responsibility to pay for equipment and services denied by Medicare. When the form is used properly, it protects suppliers from financial liability. The CMS will now allow beneficiaries to upgrade within product categories. DME providers can immediately begin using the ABN process for equipment upgrades. The use of the ABN form will become mandatory in January 2002. The ABN process has simple requirements: providers complete the ABN form (CMS R-131-G) and get the beneficiary's signature. This procedure applies to reimbursement for all categories of durable medical equipment and supplies. A properly completed ABN identifies the item or service provided, states the reason the supplier believes Medicare is likely to deny payment, estimates cost of upgrade or portion of item/service not covered by Medicare, includes patient selection of either Option 1 or Option 2, and is signed and dated by the patient. Please read more on the CMS (http://www.hcfa.gov/) website.
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