Neurology & Pain Management Coding Alert

Follow these steps to use the right form every time Ideally, Medicare reimburses your neurologist for all the services he provides -- but when it doesn-t, automatically relying on an advance beneficiary notice (ABN) to gain patient payment isn't always your best bet. The answer of whether to file an ABN depends on the situation, so follow these easy steps to correctly handle carrier-denied claims. Learn Your Terminology An ABN often comes in handy when you expect Medicare to deny payment. This can include services such as nerve conduction studies that surpass the standard frequency limit (95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study; or 95903, ... motor, with F-wave study; or 95904, ... sensory). When the patient signs an ABN prior to the procedure, she accepts payment responsibility for whatever Medicare does not reimburse.

Not so fast: An ABN, however, isn't always the most appropriate document for procedures not covered by Medicare, so don't get in a hurry to file one.

Why that is: Because ABNs are only for procedures that Medicare might not cover, you should not use them for procedures that Medicare excluded from payment. The Notice of Exclusions from Medicare Benefits (NEMB) states clearly that Medicare definitely doesn't cover a procedure regardless of the physician's specialty.

Check the form: Unlike the mandatory ABN form, providers may use notices of their own design rather than the Medicare NEMB form.

CMS recommends NEMBs as a courtesy to the patient, even though Medicare does not require them. Having the patient sign the NEMB will remind him that Medicare will not cover the procedure and that he will be billed for it.

But what if the patient signs the ABN, the physician performs the procedure, and Medicare refuses payment? What now?

You might be in the habit of obtaining ABNs for noncovered services, but having that piece of paper doesn't ensure your practice's compensation. Streamline the steps between ABNs and money in the bank by checking two details. Detail 1: Know Who's Liable In addition to understanding the regulations dictating how to get ABNs from patients, you should know how these regulations translate into payments -- or don-t.

Pitfall: Don't make the mistake of assuming that once a patient signs an ABN, you-re going to get paid. Depending on the type of liability provision the patient falls under, the ABN may not mean anything other than notification of noncovered services. Detail 2: Lock in Necessity Deciding what meets medical-necessity requirements for an ABN service isn't always easy. CMS defines medical necessity as -the determination of a service that is reasonable and necessary for the diagnosis of illness or injury, or treatment of a malformed body member.-

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