Title: Advanced Beneficiary Notice of Noncoverage (ABN)



Title: Advanced Beneficiary Notice of Noncoverage (ABN)

Presenter: Merilee Severino

Length:

Question and Answers

1) True or false. ABN forms are required to cover all services including emergency and urgent care.

a) True

b) False

2) Fill in the blank. Since ____ providers have been required to notify Medicare beneficiaries when outpatient services may not be covered by Medicare.

a) 1972

b) 1980

c) 1995

d) 2001

3) Which of the following is not an example of a statutory exclusion (i.e. never covered by Part B)?

a) Naturopathy services

b) Wheelchair van ambulance services

c) Rental or purchase of durable medical equipment for use in the patient’s home

d) Routine dental services, including dentures

4) What is the extended date for the mandatory use of the new ABN form?

a) January 1, 2012

b) March 1st, 2012

c) July 1st, 2012

d) October 1st, 2012

5)Which parts of the ABN form are the patients (or their representative) responsible for completing?

a) Blanks A-F

b) Blanks G-I

c) Blanks I-J

d) The signature portion only

6) Should a copy of the signed ABN be given to the patient?

a) No, protect the trees

b) Only if the patient requests it

c) Only when the service or item costs over $100

d) Yes, Section 40.3.4.1 outlines the reasons why

7) Which modifier would be used to indicate the circumstances where the patient or the patient’s representative has asked that an excluded service claim be submitted to Medicare for a formal determination?

a) GA

b) GX

c) GY

d) GZ

8) Which of the following is an example of the readability requirements that can be made to the ABN by provider’s offices as stipulated by CMS?

a) 12-point or higher font must be used

b) No italics

c) No highlighted or shaded text

d) All of the above

9) According to CMS the ABN form is considered to be an Office of Management and Budget (OMB) form. What does that mean?

a) It must be replaced every 3 years

b) It must be replaced every 5 years

c) There is a trademark on the form and it cannot be used for any other purpose

d) After 3 years all providers must pay an annual fee to the OMB office to use it or face fines

10) Under what circumstances may a signed blank ABN form be considered valid by CMS?

a) There are no circumstances where this is valid

b) Chiropractors can have the Medicare beneficiary sign a blank ABN form and keep it on file for use when the therapy cap is met

c) Physical therapists can have the Medicare beneficiary sign a blank ABN form and keep it on file for use when the therapy cap is met

d) All providers should ask the Medicare beneficiary to sign a blank ABN form to keep in their file

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