Optometry Coding & Billing Alert

Question: Am I allowed to change Medicare's advance beneficiary notice (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 services. By signing this form, the beneficiary acknowledges that she understands she might be responsible for paying the bill.
  
There's no requirement in place 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.    But 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 must be crossed out.
 
Also, if your practice has a logo, it must appear in the header along with your practice's name, address and telephone number. All type must be in 12-point Arial or Arial Narrow font.
 
You can download the ABN form from CMS' Web site at www.cms.gov/medlearn/refabn.asp, and complete instructions for using ABNs are at www.cms.gov/manuals/pm_trans/ab02168.pdf.