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Pulmonology Coding Alert

CMS Updates Instructions on Advance Beneficiary Notice

Published on Mon Apr 01, 2002

According to a notice appearing in the Federal Register, Feb. 19, 2002, CMS has resubmitted its package of advance beneficiary notices (ABN) and instructions for their use to the Office of Management and Budget for approval under the Paperwork Reduction Act.
 
The agency will issue final instructions around Sept. 1, 2002, at which time physicians will have to use the new forms and instructions. The forms include a general ABN for use with all services where the physician believes Medicare will not cover a service, as well as an ABN that can be used with physician-ordered lab tests.
 
According to the notice, CMS has decided to withdraw the ABN-X (CMS-R-131-X), an optional form that the agency proposed last year for services that are never paid such as wellness exams and most preventive health tests. CMS decided to eliminate the form because it was complicating the ABN process. The agency plans to provide educational materials that providers can use to inform beneficiaries of statutorily excluded Medicare services.
 
The revised instructions provide clarification, including:

 
  • Modifier -GZ (Item or service expected to be denied as not reasonable and necessary) is optional, not mandatory. It is used to bill services when providers do not have a signed ABN. "This makes sense," says Mary Falbo, MBA, CPC, a coding expert in Lansdale, Penn., "considering that in most cases physicians obtain an ABN when providing services they believe Medicare won't cover."

     
  • A witness does not have to be present to confirm a beneficiary who has refused to sign an ABN when there is only one person on site. In this case, a second individual may witness the beneficiary's refusal to sign the ABN by telephone and sign the ABN annotation later. The physician or supplier would file the claim with modifier -GA (Waiver of liability statement on file). The beneficiary is liable for payment in case of a denial.

     
  • Having beneficiaries sign a blank ABN or sign an ABN before it is completed is an abusive practice.

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