Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 15, 2008 PDF

Effective March 1, labs and physician practices must use the new combined ABN/NEMB

The Sept. 1 deadline for implementing the new ABN has come and gone -- but if your practice hasn't complied with the new form yet, take heart. CMS changed the deadline at the last minute, now allowing practices to wait until March 1, 2009 to begin using the revised advance beneficiary notice.

Earlier this year, CMS unveiled its new advance beneficiary notice (ABN). The new form not only replaced both the previous ABN-G (for physicians) and ABN-L (for laboratories), but also incorporated the notice of exclusions from the Medicare benefits (NEMB) form.

Medicare carriers began accepting the new ABN form as of March 3, but CMS has extended the transition period, allowing you until March to prepare for the new form.

The six-month extension was good news to practices that thought the Sept. 1 deadline was too soon.

"I know that a few physicians I work with told me that their speciality societies were fighting the Sept. 1 deadline," says Randall Karpf of East Billing in East Hartford, Conn. "Changing forms like that, for a large clinic, is time-consuming and expensive," Karpf says.

Last week, CMS issued a MLN Matters article regarding the new ABN, which reminds providers to use the new form for both mandatory and voluntary ABN situations.

What this means: You must issue an ABN in certain circumstances -- for instance, if you're performing care that isn't reasonable and necessary and you think Medi-care may not cover the service. However, ABN use is voluntary in other cases; for instance, if Medi-care statutorily excludes the service (such as a facelift).

To read the MLN Matters article outlining the details of the new ABN form, visit the CMS Web site at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6136.pdf.