Pathology/Lab Coding Alert

Use universal form to ensure lab test pay If your payer denies coverage because you can't show medical necessity for a lab test, you have to eat the cost -- unless you have a signed advance beneficiary notice (ABN) But an ABN wouldn't help you with statutorily non-covered services, such as many screening tests -- until now. Get familiar with CMS- new universal ABN and learn how it can help you get paid and avoid lab-test write offs. Take Advantage of Consolidated Form Before CMS unveiled its universal ABN in March, providers had to choose from several forms. Now 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 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 NEMB's previous purpose: Remember that earlier ABNs were only for procedures that Medicare might not cover due to lack of medical necessity but didn't apply to procedures that Medicare statutorily excluded from benefits. For instance, except for certain specific screening benefits, Medicare won't cover screening lab tests ordered in the absence of signs or symptoms of disease. Contrast ABN purpose: For both the previous and current versions, you should use an ABN when the patient's insurer won't cover a test because you cannot prove medical necessity, says Lena Robins, JD, senior counsel at Foley and Lardner LLP. For instance, when a Medicare carrier subjects a lab test to frequency limits, you will need a signed ABN if the physician orders the test at a shorter interval. 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." Don't worry: Although Medicare carriers began accepting the new ABN form as of March 3, CMS has implemented a six-month transition period. That means you aren't required to submit the new form until Sept. 1. Estimated-Cost Alert The new ABN (form CMS-R-131) includes Blank (F) that requires you to enter a cost estimate for the service(s) you name in the form. "The revised ABN will not be considered valid absent a good-faith attempt to estimate cost," says CMS instruction. You can download the form and the instructions from http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp. Remember 3 ABN Tips Although the ABN form has changed, many of the previous ABN "best practices" remain the same. The following is a quick look at three important ABN facts: 1. The ABN is one of your best tools to ensure payment when a lab [...]