Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 33 C

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Medicare Advanced Beneficiary Notices (ABN)"

The question by one of our doctors was:

 

"...one area I have struggled with over the years is getting a hold of an ABN (advanced beneficiary notice) for Medicare that is rock solid. 10 years ago, we were audited by MC and I had to refund some of the money because our ABN was not worded correctly. Can you help with that?"

 

New York responds: Mark, he should contact Susan McClelland through ACA. She is the premiere expert on Medicare.

 

Michigan responds: Check the Medicare website. 

 

New Jersey responds: Medicare is a federal program being administered by local contractors, ours being the one in PA.  You can go online to CMS.GOV, the Center for Medicare Services, download the ABN and more importantly, read the instructions on its use and how to have patients fill it out. Our state society has many lectures and webinars on Medicare and many of the changing requirements.

 

Kentucky responds: The official ABN is found on the Medicare website. Just use the search feature.

 

New Jersey responds: Medicare provides you with one. 

 

Oklahoma responds and adds the attachment: Medicare has their own ABN they want us to use.  Note the attached and the link below.  Hope things are getting much better for you guys out there!

http://www.acatoday.org/content_css.cfm?CID=2039

 

Colorado responds: This is too vague.  What does he mean his ABN isn't worded correctly? Use the ABN that is provided off the local provider support site.  Medicare doesn't ask for refunds because the ABN is worded wrong, they want money back when you didn't document medical necessity and document correctly.  The ABN is for when the patient goes to maintenance and you are notifying them that Medicare will no longer pay for chiropractic manipulations that are not medically necessary.  Then you need to use the appropriate modifier.  That's it!

 

Texas responds with the third attachment as well: As requested...see attachment

 

Georgia responds: This is easy.  Attached is an explanation and an ABN.  Use the form they provide and they can't complain, right?  Periodically, cms revises it, but this is the present one.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf

 

Minnesota responds: It's a free download off the Medicare website. 

http://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html

 

California responds: If you call Medicare and ask them to do an audit of your files at your office, they will tell you what is proper and they give you a get out of jail pass for priors.

 

The power of the group...Thank you all...Mark

 

Keep your questions coming...

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