News You Can Use
• Get Ready for a Whole-New ABN
If the advance beneficiary notice (ABN) form confuses your patients now, just wait until the new version debuts soon.
The Centers for Medicare & Medicaid Services proposed a new version of the ABN form in the Feb. 23 Federal Register. The new form includes information about the beneficiary’s right to demand that the provider bill Medicare for a service before paying out-of-pocket. And it now lets the patient choose among three options, instead of just two:
1. Don’t provide the service
2. Provide the service and let the patient pay out-of-pocket
3. Provide the service and bill Medicare first.
Clarification: Patients have always had the right to insist that you bill Medicare and receive a denial before billing them out-of-pocket, but the form didn’t make this clear before, says Joan Adler with Adler Advisory Services in Atlanta.
With these changes, you’ll have a harder time saying, “Medicare probably won’t pay for it. We’ll take a check now,” says Jeff Fulkerson, BA, CPC, CMC, with Emory Radiology in Atlanta. “It gives the patient a little more authority in an ABN situation.” The patient can demand that you prove Medicare won’t pay for something.
Tip: If patients are raising questions about the ABN form, try having a “mock registration session,” Fulkerson says. Have your manager act as the registration person and employees act as the patient. Then employees can run the questions that patients ask past the manager and prepare themselves for situations that may arise.
Bottom line: Make sure patients understand that “Medicare doesn’t pay for everything,” Fulkerson says. Just because they have the right to request you bill Medicare doesn’t mean Medicare will pay.
You should definitely comment on the proposed form during the 60-day comment period, says Guadalupita, N.M., consultant Melanie Witt, RN, CPC-OGS, MA. Go online to
www.gpoaccess.gov/fr/advanced.html. On this page, under “Search by Issue Date,” select “Specific Date,” select “On” and enter “02/23/2007.” After “Search:” in the next line, enter “CMS-R-131.”
To obtain copies of the ABN and supporting documents, go to
www.cms.hhs.gov/PaperworkReductionActof1995.
• Prepare to Enjoy 1-Year NPI Extension.
Good news: You’ll have an extra year to get up to snuff with your national provider identifier (NPI) compliance.
With less than two months left before crunch time, the Centers for Medicare & Medicaid Services decided to give you until May 23, 2008, to become NPI-only with all of your transactions. If you’re not quite ready by May 23, 2007, you can implement a “contingency plan” to maintain your cash flow, CMS said in a release.
Why the change: CMS tried to imply that providers weren’t ready for the original deadline. But CMS was also behind on its obligations, said the Medical Group Management Association. CMS failed to [...]
- Published on 2007-05-24
