Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 01, 2009 PDF

Combo form streamlines your work.

If you aren't using CMS's new advance beneficiary notice (ABN) yet, you're running out of time to start -- you will be required to use it as of March 1.

The new form not only replaces both the previous ABN-G (for physicians) and ABN-L (for laboratories), but also incorporates the notice of exclusions from the Medicare benefits (NEMB) form.

If your ABN skills are a bit rusty, we've got a few tips to help you keep things moving smoothly.

1. You can collect at the visit. Although some practices believe you must wait to receive the denial letter from the carrier before you can bill the patient, in most cases, that's inaccurate, points out Kim French, CIRCC, of Crouse Radiology Associates in Syracuse, N.Y.

French notes that chapter 30 of the Medicare Claims Processing Man-ual (MCPM) states, "The notifier may bill and collect funds from the beneficiary for noncovered items or services immediately after an ABN is signed, unless prohibited from collecting in advance of the Medicare payment determination by other applicable Medicare policy, State or local law."

2. Append a modifier. You'll append modifier GA (Waiver of liability statement on file) if you want to indicate that you expect Medicare to deny a specific service as not reasonable and necessary and you have an ABN signed by the beneficiary on file, the MCPM indicates. Choose modifier GZ (Item or service expected to be denied as not reasonable and necessary) if you believe the carrier will deny an item or service as not reasonable and necessary and the beneficiary hasn't signed the ABN.

3. Put the NEMB away. If Medi-care statutorily excludes the procedure from Medicare benefits, you used to use the NEMB. 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."