CMS Guidelines for Advance Beneficiary Notice (ABN)

Advance Beneficiary Notice OF NONCOVERAGE care will pay, an ABN should not be given. C. If the physician or sup-plier expects Medicare to deny payment, the next question is: On what basis is denial expected? The physician, supplier or provider must always sub-mit a claim, billing as cov-ered, for an initial determi-nation when it gave an ABN on the basis of the likelihood of denial of pay-ment. On such a claim, the physician, supplier or pro-vider must enter occurrence code 32 on the UB claim in one of the fields numbered 32 through 35. This code indicates the date the physi-cian, supplier or provider gave the ABN to the benefi-ciary. It is the occurrence code 32, and not any condi-tion code that indicates to the FI or MAC that an ABN has been issued. Oc-currence code 32 is manda-tory; it must be used any-time a signed ABN was ob-tained. CMS Guidelines for Advance Beneficiar y Notice (ABN) On Monday, March 3, 2008, CMS implemented use of the revised Advance Beneficiary Notice of Noncoverage (ABN) (CMS-R-131).

Advance Beneficiary Notice Noncoverage Page 3 Medical Necessity and ABN’s Some key features of the new form are that it: Has a new official title, the “Advance Beneficiary Notice of Noncoverage

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