Practice Management Alert

Bonus: NEMBs may be a thing of the past Billers have been waiting for months to see if CMS would actually release a new advance beneficiary notice (ABN) form that would make their lives easier. In March, you finally got your answer. CMS unveiled its new ABN, which 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. Multitask With the New Form If you dread having to decide whether an ABN or an NEMB is appropriate for your physician's services, the new ABN form will ensure those worries go away. 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. Old way: In the past, you were instructed to use ABNs only for procedures that Medicare might not cover due to lack of medical necessity. If Medicare statutorily excluded the procedure from Medicare benefits, you turned to the NEMB. You were able to use NEMBs for services such as cosmetic surgery, which Medicare never covers. Keep in mind that Medicare didn't require that you use the NEMB, whereas it requires ABNs. New way: 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. Therefore, you aren't required to submit the new form until Sept. 1. For examples of when you might need to use the new ABN, see "Increase Your ABN Know-How With These 5 Sample Scenarios" on the next page. Don't Throw Out Old ABN Rules Although CMS changed the ABN form, many of the previous ABN "best practices" remain the same. Remember these three important ABN facts to avoid services and procedures you can't collect on. Tip 1: The ABN is still one of your most important documents because Medicare requires an ABN when there is a chance of denial due to a lack of medical necessity. If you discover that Medicare won't pay for a patient's upcoming procedure and the patient still wants you to perform the service, the ABN lets 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 [...]