Radiology Coding Alert

Plus: ABNs may be getting a facelift

 Just when you thought you'd met the April 1 deadline to start using the new CMS-1500, you've got a new obstacle in your path -- incorrect versions causing returned claims.

Double-Check GPO CMS-1500

Warning: CMS revealed that the Government Printing Office (GPO) has been selling incorrectly formatted versions of the revised CMS-1500 (08-05).

The fallout: CMS is extending the original April 1 deadline for using the new form -- which allows you to report National Provider Identifiers. The projected new deadline for the new, compliant version of the form is June 1. Contractors will return any claims on the non-compliant new CMS-1500 (08-05)

What to do: You may continue to use the older CMS-1500 (12-90), and contractors must accept it until CMS instructs them otherwise. If you want to use the new form (08-05), here's how to determine whether it's compliant: Properly formatted claim forms have roughly a quarter- inch gap between the red arrow tip above the vertically stacked word "CARRIER" and the paper's top edge. If the red arrow tip touches (or nearly touches) the paper's top edge, the form is not printed to specifications.

Prepare for More Descriptive ABN

Those noncompliant CMS-1500s aren't the only forms you may need to clear out of your office. 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, says Joan Adler with Adler Advisory Services in Atlanta.
 
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.

Bottom line: Make sure patients understand that "Medicare doesn't pay for everything," Fulkerson says. Just because patients have the right to request you bill Medicare, doesn't mean Medicare will pay.