EyeNet Magazine

Savvy Coder: Coding & Reimbursement
Know These Key Features of the Revised ABN
By Sue Vicchrilli, COT, OCS, Academy Coding Executive

Effective Sept. 1, you should be using a new and improved version of the Advance Beneficiary Notice. The new form has a longer, more descriptive title—the Advance Beneficiary Notice of Noncoverage—but retains the same, familiar acronym, ABN. This Medicare form replaces the two former versions of the Advance Beneficiary Notice (ABN-G and ABN-L) and the Notice of Exclusion of Medicare Benefits (NEMB).

When to use it. The ABN should be used when there is a belief on the practice’s part that they may have an issue getting paid for a service rendered to Medicare beneficiaries that is considered to be limited based on the diagnosis and/or the frequency of the service performed.

The ABN provides your patient with three options. These are:

  • Option 1: I want the services as outlined. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.
  • Option 2: I want the services as outlined, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed. (Note: This new option allows a patient to receive item(s) or service(s) and pay for it out-of-pocket instead of having a claim submitted to Medicare.)
  • Option 3: I don’t want the services as outlined. I understand with this choice I am not responsible for payment, and I cannot appeal to see if Medicare would pay.

What service, why not, and how much. The form has a mandatory field for: the description of what service(s) might not be covered; the reason why Medicare may not pay; and cost estimates of the items to be provided and/or services to be performed.

Can you rewrite the ABN in another language? The ABN is a Medicare-approved form and cannot be altered. At time of press it was available in English and was expected to soon be available in Spanish. Physicians or their staff should document any translation assistance provided in the “Additional Information” section of the ABN.

Use modifier –GA. This is still required. It notifies Medicare that the physician’s office has an ABN on file.

The ABN is not always needed. For instance, refractions and cosmetic or refractive procedures don’t need one.

Download the form. The ABN, along with the CMS instructions for its use, can be found under “Coding Tools” at www.aao.org/aaoesite/coding/.

Questions? E-mail coding@aao.org.


Coding in Atlanta

GOT A CODING CONUNDRUM? Visit the Coding Questions desk at the Academy Resource Center to chat with AAOE experts (above) and to browse the AAOE’s coding resources, like Coding Coach and Code This Case.

TWO SPECIAL EVENTS. Saturday’s AAOE Coding Camp: A Workshop to Appropriately Maximize Reimbursement (8 a.m. to 3:30 p.m., with breakfast from 7 to 8 a.m.; advance ticket fee is $315; event code “Camp”) and Tuesday’s Ophthalmology Coding from A-Scans to YAGs—12:45 to 3 p.m. (no ticket is needed for this free event; “Spe42”).

ELEVEN INSTRUCTION COURSES. From Sunday’s Introduction to Coding—2 to 4:15 p.m. ($50; “226”) to Tuesday’s Oculoplastic Coding—12:45 to 1:45 p.m. ($25; “599”), they are all approved for group A CE credits.

To buy event tickets, visit www.aao.org/2008.


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