Gastroenterology Coding Alert

Heads up: These 3 principles remain the sameCMS has unveiled its new advance beneficiary notice (ABN), and even though the hard deadline is several months away, you should take steps now to put it into practice.Good news: The new ABN not only replaces the previous ABN-G (for physicians) but also incorporates the notice of exclusion from Medicare benefits (NEMB) form. CMS expects this new, combined form to "eliminate any widespread need for the NEMB in voluntary notification situations," according to the new ABN Form Instructions document.The NEMB's previous purpose: In case you weren't familiar with exactly when you were supposed to use the ABN rather than the NEMB, keep in mind that in the past, ABNs were only for procedures that Medicare might not cover but didn't apply to procedures that were statutorily excluded from Medicare benefits. That was where the NEMB came in -- you were able to use it for services such as cosmetic surgery, which Medicare never covered.Now CMS will accept the new ABN form for either purpose, noting in its ABN Instructions that "the revised version of the ABN may also be used to provide voluntary notification of financial liability."Don't worry: Although Medicare carriers began accepting the new ABN form as of March 3, CMS has implemented a six-month transition period. Therefore, you aren't required to submit the new form until Sept. 1.Although the ABN form has changed, many of the previous ABN "best practices" remain the same. Following is a quick look at three important ABN facts.All Hail the Importance of the ABNIf you discover that a patient's upcoming procedure is not payable by Medicare but the patient still wants you to perform the service, the ABN will let the patient know that he may be responsible for paying the noncovered portion.ABNs help patients decide whether they want to proceed with a service even though they might have to pay for it. A signed ABN ensures that the physician will receive payment directly from the patient if Medicare refuses to pay. Without a valid ABN, you cannot hold a Medicare patient responsible for the denied charges, says Kara Hawes, CPC-A, coder with Advanced Professional Billing in Tulsa, Okla."The patient has to sign the ABN form at the time of service, otherwise the form is not valid," Hawes says. "When the claim is denied without an ABN, Medicare will not allow you to be reimbursed for the service or collect money from the patient."Explain the ABN to the PatientABNs help the patient understand his options. Once you have completed the ABN and discussed it with the patient, he can: 1) sign the ABN and assume financial responsibility for the procedure in question; 2) cancel the procedure; [...]