Ophthalmology and Optometry Coding Alert

Question: We do lots of pachymetry procedures that are rejected by Medicare, so we have our patients fill out an advance beneficiary notice (ABN) beforehand. Am I allowed to change Medicare's ABN form to better suit my practice's needs?
     
North Carolina Subscriber

Answer: Not really. CMS has strict guidelines that  medical offices must follow when using an ABN, which is a federal form used to inform a Medicare beneficiary that the program might not pay for certain procedures or services. By signing this form, the beneficiary acknowledges that she understands she might be responsible for paying the bill. 
 
There's no requirement that says you must use ABNs. But if you don't, your practice will be missing out on reimbursement, because you're not allowed to bill a Medicare beneficiary for a denied claim without a signed ABN on file. Keep in mind, however, that ABNs "are not for use for patients who are not Medicare beneficiaries," CMS emphasizes in its instructions on using the form. And if you tinker with CMS' form, you render it null and void - and therefore you can't bill the patient.
 
However, there is one part of the form you should alter slightly: the "user-customizable" section where you insert the service description and the reasons you expect Medicare to deny the claim.
 
You can list commonly denied services with check-off boxes on the ABN in the appropriate denial column, according to CMS instructions.
 
This is your one chance to customize the form, as long as you don't change the columns' captions. You can hand-write a particular service in the appropriate column or you can preprint the ABN with small check boxes next to specific services, but CMS requires that every test and box not checked be crossed out.

 - Answers to Reader Questions and You Be The Coder were contributed by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; Dennis Sandoval, MD, Eye and Facial Surgery of New Mexico, Albuquerque; and John Bell, CEO, Maine Eye Care, Waterville.