Still Using the Old ABN, NEMB Forms? Stop Now

Posted on 25. Mar, 2009 by Editor in Hot Coding Topics

Surprise! Here’s when the new form puts you on the OIG’s hot list.

The drop-dead date for using the updated advance beneficiary notice (ABN) just passed, so it’s out with the old and in with the new.

While the new form was first introduced last year, you haven’t been required to use it — until now. With March 1 behind us, you’re asking for denials if you’re still using the old forms.

Are your practice’s billing processes a little ‘antique?’ Bring them into the 21st century and maximize reimbursement with Kenneth Engel’s webinar.

You Now Have a Streamlined Form

The new form not only replaces both the previous ABN-G (for physicians) and ABN-L (for laboratories) but also incorporates the Notice of Exclusions from Medicare Benefits (NEMB) form, says Melinda S. Brown, CMBS, insurance biller for a primary-care provider in Kennewick, Wash.

CMS expects the new combination form to “eliminate any widespread need for the NEMB in voluntary notification situations,” according to the new “ABN Form Instructions” document.

Old way: In the past, you used the ABN form only for procedures that Medicare might not cover due to medical necessity. However, the ABN didn’t apply to procedures or items that were statutorily excluded from Medicare benefits. For those services, you turned to the NEMB form. You used the NEMB for services beyond the stated limits (that didn’t fall under an exception) because Medicare never covered them. NEMB forms were optional, not payer-required.

New way: Now CMS accepts the new ABN for either purpose, noting that “the revised version of the ABN may also be used to provide voluntary notification of financial liability.” This means you can use the new ABN form when you would have used an...

Tags: ABN, advance beneficiary notice, billing, modifier GA, modifier GY, modifier GZ, NEMB, Notice of Exclusions from Medicare Benefits