The Office of Management and Budget (OMB) has approved the Advance Beneficiary Notice of Noncoverage (ABN) form and instruction for renewal. In this article, I will provide the answers to the following questions:

This article was updated on August 3, 2020 as CMS did change the effective date. Per the Centers for Medicare and Medicaid Services, the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on I hope you found this article helpful. Thank you for being a Gold Member!

The Centers for Medicare and Medicaid Services (CMS) has released an updated transmittal providing instructions when a skilled nursing facility (SNF) should and should not issue an advance beneficiary notice of non-coverage (ABN) to a Medicare beneficiary. To read the SNF ABN instructions of when to and when not to issue a SNF ABN, ABN specific delivery issues, special rules for SNF ABN’s, establishing when beneficiary Is on notice of non-coverage, and sources of beneficiary notification, click

In this week’s article, I wanted to answer some of the most commonly asked questions I receive concerning the Medicare therapy threshold (formerly, the Medicare therapy cap), the KX modifier, claims exceeding $3,000 in a calendar year and when to and when not to use an advance beneficiary notice of noncoverage (ABN) for Medicare beneficiaries who exceed the annual therapy threshold and $3,000 in a calendar year. In this article, I will answer the following questions: 1. Why is it called the therapy threshold and not the therapy cap? 2. Why must I still use the KX modifier? 3. Will

In this week’s article, I wanted to answer some of the most commonly asked questions I receive concerning the Medicare therapy threshold (formerly, the Medicare therapy cap), the KX modifier, claims exceeding $3,000 in a calendar year and when to and when not to use an advance beneficiary notice of noncoverage (ABN) for Medicare beneficiaries who exceed the annual therapy threshold and $3,000 in a calendar year. In this article, I will answer the following questions: 1. Why is it called the therapy threshold and not the therapy cap? 2. Why must I still use the KX modifier? 3. Will

The Advance Beneficiary Notice of Non-Coverage (ABN) is used when normally the service(s) or item(s) would be covered by the Medicare program, but under the circumstance, a provider does not think their Medicare Administrative Contractor will pay for a service(s) or item(s). A question I have been receiving lately is can a provider of outpatient therapy services use an ABN for Medicare Advantage (MA) plans to indicate to the MA plan that they (the provider) believe the MA will not pay for a service(s) or item(s)? The ABN is to be used

Since passage of the 2018 Bipartisan Budget Act of 2018 that repealed the therapy cap for outpatient therapy services, I have been receiving many questions about the application of the KX modifier for services that exceed either $2010 or $3000 physical therapy and speech therapy combined in 2018 or a separate $2010 or $3000 for occupational therapy. Most of the questions center around should I provide the Medicare beneficiary with an advance beneficiary notice of noncoverage (ABN)  when they exceed either $2010 or $3000 in calendar year 2018? In this article, I will answer the following questions: If the therapy

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. 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. To access the revised form and ABN form instructions for completion, click