ED Coding and Reimbursement Alert

Update now if you-re not already using the revised form If you-ve never quite understood when you should provide a patient with an ABN rather than an NEMB (Notice of Exclusions from Medicare Benefits) for a noncovered service, CMS has just made your life easier. Earlier this month, the agency unveiled its new advance beneficiary notice. This new form not only replaces the previous ABN-G (for physician services) but also incorporates the 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 the NEMB
came in. The new way: 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 says. Get ready for the change now: Medicare carriers began accepting the new ABN 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 it easier to make the change immediately. 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. Remember These 5 ABN Tips Although the ABN form has changed, many previous ABN "best practices" remain (mostly) the same. Here are five guidelines to follow anytime you use the form: 1. Observe CMS- "duress" rule: Discussing ABNs with ED patients does not violate patient anti-dumping laws, provided the patient is not "under duress" while the discussion takes place. The Emergency Medical Treatment and Labor Act (EMTALA) calls for physicians to screen and stabilize patients first; but then, they can inquire about the patient's insurance. In short, as long as the physician does not postpone treatment or engage in "economic coercion," he can discuss an ABN with the patient. According to Medicare Transmittal AB-02-114, "physicians and suppliers may not use ABNs to shift financial liability to beneficiaries in emergency care situations." However, many compliance experts have taken the position that the ED setting implies an emergency care situation regardless of the initial presenting complaint. So you may want to check with your Medicare carrier before submitting an ABN. 2. Provide the ABN up-front: If you discover that a patient's upcoming procedure is not payable by Medicare but the patient still wants [...]