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I received an ABN that was not on the standard gov't form. Is it legitimate?

I received an Advance Beneficiary Notice (ABN) that was not on the standard government form CMS-R-131. Is it a legitimate ABN?

The CMS-R-131 came into use in June 2001 and is expected to be the only ABN in use by September 2002. In the meantime, you may receive ABNs using the old approved model language which follows:

Physician/Supplier Notice: Medicare will only pay for services that it determines to be "reasonable and necessary" under section 1862(a)(1) of the Medicare law. If Medicare determines that a particular service, although it would otherwise be covered, is "not reasonable and necessary" under Medicare program standards, Medicare will deny payment for that service. I believe that, in your case, Medicare is likely to deny payment for (particular services) for the following reasons: (reasons for predicting denial).
Beneficiary Agreement: I have been notified by my physician/supplier that he or she believes that, in my case, Medicare is likely to deny payment for the services identified above, for the reasons stated. If Medicare denies payment, I agree to be personally and fully responsible for payment. Signed, (Beneficiary Signature).

Under the rules for using the older ABNs, your physician, supplier, or provider may have modified the above notice language for their own use. The new ABN, however, is a standard form. If you receive one of the older ABNs, signing the ABN is the same as choosing "Option 1. YES" on the new ABN. If you refuse to sign, it is the same as choosing "Option 2. NO" on the new ABN, that is, you probably will not receive the item or service.

FAQ_Category: 
Payment and Billing
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