Understanding the Updated CMS Form CMS-10055What Providers Need to Know About the Advance Beneficiary Notice of Non-Coverage

10/25/2024 - By Kelly Smith, PhD, CPHQ, CLSSBB

The Centers for Medicare & Medicaid Services (CMS) has recently issued updates to the Advance Beneficiary Notice of Non-Coverage (ABN), Form CMS-10055. This form is critical for healthcare providers to notify Medicare beneficiaries when services they are receiving may not be covered by Medicare, and that the patient may be responsible for paying out-of-pocket. The updated form and accompanying instructions bring several changes aimed at improving clarity and compliance to protect both providers and beneficiaries.

Specifically, implemented changes were designed to:

Revise language for clarity to ensure Medicare beneficiaries can more easily understand the potential costs of services not covered by Medicare.
Improve the layout and format to emphasize critical information such as why Medicare may deny coverage and the estimated costs, making it easier for beneficiaries to comprehend their options and responsibilities.
Provide clearer guidance to providers on how/when to issue the ABN properly and emphasize the importance of educating beneficiaries to prevent potential financial disputes.

Beginning October 31, 2024, skilled nursing facilities will be required to use the updated form which can be found at www.cms.gov/medicare/medicare-general-information/bni/downloads/snfabn2018v508-122017_clean-cms-10055.docx

If you have questions about this new form, Saltmarsh’s https://www.saltmarshcpa.com/cpa-services/healthcare-consulting.asp can help.

About the Author | Kelly Smith
Dr. Kelly Smith is a director in the Healthcare Consulting practice of Saltmarsh, Cleaveland & Gund. She has more than a decade of experience devoted to improving the quality of life and care for seniors and a strong background in quality framework implementation and process improvement. She served as the Director of Process Improvement for Opis Senior Services Group which provided skilled nursing, assisted living, home health services and short-term rehabilitation services. Dr. Smith supports provider efforts in the formation of integrated, system-based operations using data analytics to drive decision-making and seeks to transform the delivery of senior services through the design of customized process improvement initiatives, leadership development and dissemination of best practices.