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Alert! Medicare: ABN Updates

Effective Thursday, Oct 14, 2021, there will be some changes to the purpose of the Advanced Beneficiary Notice (ABN) form.  However, the form itself is not changing.

The only major change for chiropractors is beginning October 14, 2021, an ABN no longer expires after 1 year.  An ABN is good for a repetitive service as long as there are NO CHANGES.  Therefore, a yearly signed ABN is no longer needed, unless something has been modified or is different. Nevertheless, you may continue to have a new ABN signed yearly if you so choose.

A new signed ABN is required for the following:

  • An item changes
  • Maintenance care resumes after a period of active care (ie: if a patient is injured and treatment is covered by Medicare and they are returning to maintenance care)
  • If the service changes. The most likely service change would be a difference in the cost of the service being billed to the patient.

Medicare ABN Form Expiration June 2023

While that is the only major change for chiropractors, WPS did re-emphasize a number of other factors that are clearly laid out in the rules:

  • DO NOT use an ABN for a Medicare Advantage patient
  • When you have an ABN signed, you must provide a copy for the patient (may be carbon or photocopy)
    • If the patient requests a paper copy, you must provide a copy upon request
    • If the patient requests an email, you must track the email to confirm it was received
    • If the patient leaves their ABN copy behind, you must note that in their records, and that you have a copy
  • You may not change the font or size of the print on the ABN form.  You may fill in the blanks but only with the same size and font.
  • Handwritten ABNs must be legible or they will be denied
  • A form can be customized but do not change the verbiage, otherwise it is invalid
  • Too many, or unapproved changes make the form invalid
  • The entire form must be completed in the same language (English or Spanish)
  • The name of your business is listed in box (A) on the ABN.  In box (C), enter your internal number such as the patient account number.  DO NOT place the patient’s social security number on the form.  Box (C) can be left blank.
  • In box (D), remove the “D.” and insert a description of the service that the patient will understand such as “Chiropractic Manipulation” or “Adjustment”.  It is also recommended that you list the frequency of visits and/or how long you expect to see them for this issue.
  • Box (E) should be an explanation of why the service is not covered in a way the patient will understand


  • in Box (G),  you cannot tell the patient which option to select, you can only provide information on the three (3) options
  • A new ABN is NOT needed if the patient changes their mind and wants to switch from Option #2 to Option # 1
  • For Dual eligible patients (patients that have Medicare as primary and Medicaid as secondary),  you must draw a line through the following section when you are using an ABN for maintenance care:
    • I understand that if Medicare doesn’t pay I am responsible for payment, but I can appeal to Medicare by following the instructions on the MSN.
      • You must draw a line through it but DO NOT remove it from the form.
  • The person delivering the ABN must be able to explain all parts of it and all questions must be answered.  Patients can be referred to 1-800-Medicare (800-633-4227) if they have additional questions or need more information.
  • If a representative signs for the patient, list the relationship of the representative to the patient
  • The ABN can still be used for non-covered services such as exams, x-rays and therapies, however, it must be a separate form from the one you are using to inform a patient of maintenance care adjustment issue
    • I still suggest using a separate form you make up in your office when dealing with non-covered services. It helps to avoid having to address a number of rules that come into play when using an ABN for non-covered services.
  • Timeframe to refund overpayments:
    • 15 days if a refund is due to the patient
    • 30 days if a refund is due to Medicare

Contents compliments of Dr. Brad Stauffer, Nebraska Medicare CAC Representative 

Money Tree Billing is a chiropractic billing company who removes the distraction of billing from your office so you can focus on changing lives through chiropractic care. Money Tree Billing offers complete billing cycle management through a dedicated and seamless billing process. We empower you and your team with support beyond just billing. Focus on your practice and your passion and we’ll focus on getting you paid. We GUARANTEE our work. Money Tree Billing guarantees if your insurance claim goes unpaid due to our error, that we will credit you the amount you would have been paid on that claim. You won’t find another guarantee like it in the industry. To learn more about Money Tree Billing, and our one-of-a-kind guarantee, visit


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