Ophthalmology and Optometry Coding Alert

Question: I've read that there's a new ABN form floating around out there, but I can't find it anywhere. Can you tell me where to look?


New York Subscriber


Answer: There are actually three new versions of an advance beneficiary notice (ABN) form now. You can find all three by going to www.cms.hhs.gov/PaperworkReductionActof1995. Click on PRA Listing on the left side of the page. Then search for "CMS-R-131" on the search page. This will take you to a page from which you can download the new ABN information, including a summary of the changes and the new forms.

The three versions of the form include a generic form that you can customize to the types of services you provide, a form using the term "items or services," and a form that uses the term "laboratory tests" and other customizations illustrating laboratory-specific use.

There are two main reasons to obtain a signed ABN from patients:

• to ensure reimbursement for services provided but deemed not covered by Medicare
• to reduce the risk of compliance implications associated with ABNs.

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. You must also append modifier GA (Waiver of liability statement on file) to the service in question when you submit the claim for which you obtained an ABN.

Without a valid ABN and appropriate claim reporting, you cannot hold a Medicare patient responsible for the denied charges, leaving the bill in the physician's lap.

Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla.