Medicare Releases New Required ABN Form For Chiropractors

[Update] Here’s a quick update to the original post with a FAQ answered by the Feds themselves!

One FAQ everyone is asking after my last post is this:

Q: What do we do with current ABN’s that are in place? Are they invalid? Do we need to re-do them?

A: If you have a current ABN on file, they can be valid for up to one year.  So there would be no need to start a new one on June 21.

However, if you are delivering a new ABN on June 21st (or thereafter), you must use the new form.


ABN question


If you missed the original post, it follows below


[Original Post]

Effective June 21, 2017, chiropractors – and all physicians – will be required to utilize a newly published ABN form (Advanced Beneficiary Notice).

While the changes to the form are minor, the implications are major: use the new form by the launch date or face penalties.

Here are a few questions that we’ve already been receiving 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. Still required because you participate in Medicare.

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

A:        A 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 previous post: Why Chiropractors Get the Medicare ABN Wrong 

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:           You’ve got bigger problems than the ABN.! Here’s the really bad news:  If you are not enrolled in Medicare as a chiropractor, you don’t have any billing privileges in           Medicare which means that — ABN or not — you can’t legally be collecting anything from Medicare patients.  Fix this fast.

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 (see above).

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 has not changed.