New Medicare ABN Form Required For Chiropractors

Effective June 21, 2017, Medicare will require all chiropractors to utilize the newly published ABN (Advanced Beneficiary Notice) form.  The changes to the form are minor, however, the consequences for not using the new form are major: use the new ABN form by the launch date or face penalties.

Here are a few FAQs about the new ABN form from the chiropractic profession:

Q:        Are chiropractors required to use the new ABN form or can we just continue to use the old form?

A:        Effective June 21, 2017, you will need to use the new form – version Form CMS-R-131 (Exp. 03/2020).

Q:        Do I have to use the form if I am Non-Par with Medicare? 

A:        Yes, the new ABN is required for all Medicare providers regardless of your participation status.

Q:        I heard the new ABN is being used to include information on the Non-Discrimination requirements, but I am exempt from those. So do I still have to use the new form?

A:        Yep, there’s no way around it.

Q:        What happens if I don’t use the new ABN form?

A:        Any healthcare provider who fails to comply with the ABN instructions risks financial liability and/or sanctions.

Q:        Is the new Medicare ABN form required every visit?

A:        No. The ABN form is mandatory only when chiropractors are going to be providing a service that is usually paid for by Medicare under Part B (the chiropractic adjustment) but may not be paid for in this particular case because it is not considered medically reasonable and necessary (ex: Maintenance care adjustment). For more info on how to properly use the Medicare ABN, you might want to check out my post:  Medicare ABN…what is it and how to use it.

Q:        Where can I get a copy of this new Medicare ABN?

A:        The link to the new ABN Form and instructions for use is here.

Q:         What if I am not enrolled in Medicare as a chiropractor — do I still have to use this new ABN?

A:           If you are not enrolled in Medicare and are treating Medicare patients, you’ve got bigger problems than the ABN!   If you are not enrolled in Medicare as a chiropractor, you don’t have any billing privileges in Medicare.  This means you can’t legally be collecting anything from Medicare patients…..ABN or not.  Fix this NOW!  Click here for help with credentialing.

Q:          What if I’ve opted out of Medicare, do I still need to use the ABN?

A:          If you are a chiropractor, you do not have the option of opting out of Medicare.  You’re in – like it or not.  You may have failed to enroll, but that’s a different problem and not a good one either (go back to the previous question).

Q:           Is there some new code or new modifier I need to use to communicate to Medicare that I’m using the newly required ABN form?

A:           No, not at this time.  The billing and coding aspect of using the ABN form have not changed.  Continue to use the appropriate ABN modifier.  For more information on Medicare modifiers, click here.