Questions About the Medicare Brochure and Medicare Worksheet?

Here is some clarification about the new Patient Media Medicare materials that inform your patients about Medicare excluded services and how Medicare works in your practice.

Kathy Mills Chang, MCS-P served as subject matter expert for the Medicare brochure and Medicare worksheet. As a Certified Medical Compliance Specialist, she has trained chiropractors for more than 20 years on these procedures. This is her explanation:

Rest assured, we are not recommending that you change your existing system of using the required ABN form--when it's required.

You may not be aware that an ABN form is NOT required for explaining the excluded services to your patients. Nor does Medicare require that you get anything signed by them, since they are services that they never cover anyway. An ABN is only required when you must notify a Medicare patient that one of the three spinal manipulations codes, 98940, 98941, or 98942, are likely NOT to be covered due to what would most likely be maintenance care. When surveyed, more than 75% of doctors had the mistaken belief that an ABN was required for the non-covered/excluded services. In fact, when you elect to use Medicare's official form for the purpose of notification, it may subject you to additional rules and regulations and modifier usage that practically invites the possibility of an expensive error--all for something that's not required!

ABN BookletHere is some information you can refer to:

DEPARTMENT OF HEALTH AND HUMAN SERVICES - Centers for Medicare & Medicaid Services publishes Medicare Learning Network (MLN): Official CMS Information for Medicare Fee-For-Service Providers. Here is information on the latest MLN on ABN:

Medicare Learning Network: Advance Beneficiary Notice of Noncoverage (ABN) Part A and Part B, Fourth Edition ICN 006266 November 2013

The entire MLN article can be found here. Notice on the bottom of page 1 it says:

"You may also use the ABN as an optional (voluntary) notice to alert beneficiaries of their financial liability prior to providing care that Medicare never covers. ABN issuance is not required to bill a beneficiary for an item or service that is not a Medicare benefit and never covered."

These Patient Media materials offer a superior way to explain the excluded services, making it clearer for the typical Medicare patient to understand. It also will aid in alleviating confusion over the ABN form and its purpose. When the official ABN form is only used as it is intended, it makes it easier to explain when you know the adjustment will not be covered, rather than trying to use it to explain all of the absolutely excluded services such as exams, X-rays and adjunctive services.

The brochure is best used as a preamble to completing the worksheet, which is used to explain the fees and the expected first-visit charges. There is a place the patient can sign so the doctor can keep a copy and provide the original to the patient. This is a much easier to understand alternative to the improper use of the Medicare ABN form for excluded services.

Additionally, the "Ugly ABN" referred to in the Patient Media catalog refers to the excluded services ABN only. You would never need an ABN that has multiple signatures for several visits, because once an ABN is signed for a CMT code that is not covered, it's good for up to one year.

If you still have questions, please email them directly to Kathy.