CMS Notices on Advance Beneficiary Notice of Noncoverage, Hospital Appeal Notices and Detailed Notice of Discharge

Members have brought two CMS notices to our attention recently.

Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50. 
 
What's New?

In March 2017, the Office of Management and Budget  (OMB) has approved the renewal of the ABN, Form CMS-R-131, and form instructions. While there are no changes to the form itself, providers should take note of the newly incorporated expiration date on the form.  With the 2016 PRA submission, a non-substantive change has been made to the ABN. In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed.  The effective date for use of this ABN form is 6/21/2017.
 
Here is the CMS webpage with the announcement and links to the ABN form and instructions (https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html).

 

Hospital Appeal Notices & Detailed Notice of Discharge

 

Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable.

What's New?

The effective date for use of the updated IM and DND is 60 days from June 29, 2017. There have been a number of updates to this CMS message.

Here is the CMS webpage with the latest notices (https://www.cms.gov/Medicare/Medicare-General-Information/BNI/HospitalDischargeAppealNotices.html).

You may have seen this most recent notice on CMS-R-193:

On June 7, 2017, the Centers for Medicare & Medicaid Services (CMS) posted new versions of the Important Message from Medicare (IM) form (CMS-R-193) and the Detailed Notice of Discharge (DND) form (CMS 10066) on the Beneficiary Notices Initiative webpage. The associated instructions for use are also available.

The new IM form incorporates the following language related to discrimination - "For more information, call 1-800-MEDICARE (1-800-633-4227), or TTY: 1-877-486-2048. CMS does not discriminate in its programs and activities. To request this publication in an alternate format, please call: 1-800-MEDICARE or email: AltFormatRequest@cms.hhs.gov." The Detailed Notice also has new language related to discrimination. Both forms have new expiration dates.

CMS is requiring that the new version of these forms must be in use by August 28, 2017.