New ABN Will Free You From NEMB Confusion

Update now if you’re not already using the revised form
If you 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.
Earlier this month, the agency unveiled its new advance beneficiary notice (ABN). This new form not only replaces the previous 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 you would have used the NEMB instead.
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 confirms.
Get ready for the change now: Medicare carriers began accepting the new ABN form as of 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 http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp.

Remember These 3 ABN Tips

Although the ABN form has changed, many of the previous ABN best practices remain (mostly) the same. Here are four guidelines to follow anytime you use the form.
1. Provide the ABN up-front. If you discover that a patient’s upcoming procedure is not payable by Medicare 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 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 cannot hold a Medicare patient responsible for the 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 [...]

- Published on 2008-05-09