Ophthalmology and Optometry Coding Alert

Update now if you're not already using the revised formIf your practice is like most ophthalmology offices, every day you perform services, like refractions, that Medicare does not cover. If you've 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.Medicare has unveiled its new advance beneficiary notice. This new form not only replaces the previous advance beneficiary notice (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 the NEMB came in.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 says.Get ready for the change now: Medicare carriers began accepting the new ABN on 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 making the change immediately a little easier.How to get it: You can view a sample copy of the revised ABN, as well as CMS' complete instructions for implementing and using the form, on the CMS Web site at http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp.Although the ABN form has changed, many previous ABN "best practices" remain (mostly) the same. Here are four guidelines to follow anytime you use the form.1. Provide the ABN Up-FrontIf you discover that Medicare won't pay for a patient's upcoming procedure but the patient still wants you to perform the service, the ABN will inform the patient 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. A signed ABN ensures that the physician will receive payment directly from the patient if Medicare won't pay. Without a valid ABN, you cannot hold a Medicare patient responsible for 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."2. Explain the ABN to [...]