Medicare Compliance & Reimbursement

Say goodbye to payment up front for non-covered services.

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 (CMS) 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 always have 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, notes Joan Adler with Adler Advisory Services in Atlanta, GA.

These changes will make it harder for you to say, "Medicare probably won't pay for it. We'll take a check now," says Jeff Fulkerson 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 advises. Have your manager act as the registration person and employees act as the patients. Then employees can run the questions that patients ask past the manager and prepare themselves for possible 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, advises Guadalupita, NM consultant Melanie Witt. Go 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 online to www.cms.hhs.gov/PaperworkReductionActof1995.