Neurosurgery Coding Alert

Update now if you-re not already using the revised form If you never quite understood when you should provide a patient with an ABN rather than an NEMB for a noncovered service, CMS has just made your life easier. Earlier this month, the agency unveiled its new advance beneficiary notice (ABN). This new form not only replaces the previous ABN-G (for physician services) but also incorporates the notice of exclusions 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 old way: Previously, you would use an ABN only for procedures that Medicare might not cover. The ABN did not apply to procedures that CMS statutorily excluded from Medicare benefits -- that's where you would have called on the NEMB, instead. The new way: Now, CMS will accept the new ABN form for either a "potentially noncovered" service or for a statutorily excluded service. "The revised version of the ABN may also be used to provide voluntary notification of financial liability," CMS confirms. Get ready for the change now: Medicare carriers began accepting the new ABN form as of March 3, but CMS has implemented a six-month transition period. Although you aren't required to submit the new form until Sept. 1, you may find it easier to make the change immediately. How to get it: You can view a sample copy of the revised ABN, as well as instructions for implementing and using the form, on the CMS Web site http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp. Remember These 3 ABN Tips Although the ABN has changed, many ABN "best practices" remain (mostly) the same. Here are three guidelines to follow anytime you use the form. 1. Provide the ABN up-front: If 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, 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." [...]