Effective ABN Delivery

50.8 - Effective ABN Delivery (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) ABN delivery is considered to be effective when the ABN is: 1. Delivered by a suitable notifier to a capable recipient and comprehended by that recipient. 2. Provided using the correct OMB approved notice with all required blanks completed. Failure to use the correct notice may lead to the notifier being found liable since the burden of proof is on the notifier to show that knowledge was conveyed to the beneficiary according to CMS instructions. 3. Delivered to the beneficiary in person if possible. 4. Provided far enough in advance of delivering potentially non-covered items or services to allow sufficient time for the beneficiary to consider all available options. 5. Explained in its entirety, and all of the beneficiary’s related questions are answered timely, accurately, and completely to the best of the notifier’s ability. The notifier should direct the beneficiary to call 1-800-MEDICARE if the beneficiary has questions s/he cannot answer. If a Medicare contractor finds that the notifier refused to answer a beneficiary’s inquiries or direct them to 1-800- MEDICARE, the notice delivery will be considered defective, and the notifier will be held financially liable for non-covered care. 6. Signed by the beneficiary. A. Period of Effectiveness/Repetitive or Continuous Non-covered Care An ABN remains effective after valid delivery so long as there has been no change in: • Care from what is described on the original ABN; • The beneficiary’s health status which would require a change in the subsequent treatment for the non-covered condition; and/or • The Medicare coverage guidelines for the items or services in question (i.e., updates or changes to the policy of an item or service). NOTE: If any of the above changes during the course of treatment, a new ABN must be issued. For items or services that are repetitive or continuous in nature, notifiers may issue another ABN to a beneficiary after one year for subsequent treatment for the non- covered condition. However, this is not required unless any of the conditions described above apply to the given situation. Notifiers may give a beneficiary a single ABN describing an extended or repetitive course of non-covered treatment provided that the ABN lists all items and services that the notifier believes Medicare will not cover. If applicable, the ABN must also specify the duration of the period of treatment. If during the course of treatment additional non- covered items or services are needed, the notifier must give the beneficiary another ABN. If a beneficiary is receiving repetitive non-covered care, but the healthcare provider or supplier failed to issue an ABN before the first or the first few episodes of care were provided, the ABN may be issued at any time during the course of treatment. However, if the ABN is issued after repetitive treatment has been initiated, the ABN cannot be retroactively dated or used to shift liability to the beneficiary for care that had been provided before ABN issuance. In cases such as this, care that was provided before ABN delivery would be the financial responsibility of the healthcare provider or supplier. B. Incomplete ABNs Allegations of improper or incomplete notices will be investigated by Medicare contractors. If the notifier is found to have given improper or incomplete notice, the applicable Medicare contractor will not hold the beneficiary liable in the individual case. C. Electronic Issuance of the ABN Electronic issuance of ABNs is not prohibited. If a healthcare provider or supplier elects to issue an ABN that is viewed on an electronic screen before signing, the beneficiary has the option of requesting paper issuance over electronic if that is what s/he prefers. Also, regardless of whether a paper or electronic version is issued and regardless of whether the signature is digitally captured or manually penned, the beneficiary should be given a paper copy of the signed ABN to keep for his/her own records.