Resolve To Use The New CMS ABN In 2012!

The Advanced Beneficiary Notice of Noncoverage (“ABN”) is a form that is used by health care providers, including physicians, when they expect Medicare to deny payment.  More specifically, each and every time that you, the provider, believe that Medicare will deny a charge, you must have the patient complete the ABN (which is linked to a specific date of sesrvice), acknowledging that he/she has been advised that Medicare may not pay for the service, but that he/she wants the service regardless, and agrees to be financially responsible for it.  An example might be a Medicare patient seeking a complete physical (as distinguished from the annual wellness visit!) – a service that Medicare will not cover.  Having this date-of-service-specific ABN is the only way that a provider can legitimately transfer a charge that was denied by Medicare as a non-covered service to the patient for payment.

The Centers for Medicare and Medicaid Services (CMS) has revised the ABN, Form CMS-R-131. The revised form replaces ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007).   The CMS website has links to the new form and instructions for use of the new ABN form, respectively:  https://www.cms.gov/BNI/02_ABN.asp 

Use of the revised ABN form (which has a release date of 3/2011 printed in the lower left hand corner) will be mandatory starting January 1, 2012, however it is certainly available for current use as well.   Any ABNs submitted after 1/1/2012 which have a release date of 3/2008 printed in the lower left hand corner will be deemed invalid, and the patient will NOT be deemed liable for any charges that remain denied as non-covered by Medicare.

Slight 5010-Compliance Reprieve

CMS has announced that it will NOT enforce 5010 non-compliance until March 31, 2012.  This is a slight reprieve, but all HIPAA covered entities should be actively in testing mode, and continually “working with their trading partners to become compliant with the new HIPAA standards, and to determine their readiness to accept the new standards as of January 1, 2012.”

For the full text of the CMS statement, please see: https://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf

CMS’ Revalidation Effort Delayed

Over the past few months, much has been discussed about CMS’s “revalidation” effort.  Essentially, all providers and suppliers enrolled in the Medicare program prior to March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (Section 6401a).  Providers/suppliers who enrolled on or after March 25, 2011, have already been subject to this screening and need not revalidate at this time.

CMS & MACs have advised providers and suppliers not to take any action intil they have received a “revlidation letter” from their MAC, for this is going to be a staged process in which all providers and suppliers would be revalidated over the course of the next two years (by March 23, 2013).  The followig link provides an example of what a validation letter would look like:  http://www.palmettogba.com/Palmetto/Providers.Nsf/files/J11_Revalidation_Letter_Web_Example.pdf/$File/J11_Revalidation_Letter_Web_Example.pdf. 

Once your office receives such a notice, please notify M.E.D.I.C., Inc. ASAP, for at that point, you have only 60 days in which to complete the revalidation process.  Providers failing to respond to such a revalidation request run the risk of being deactivated from the Medicare program.

Just this past week, however, CMS announced that it would “delay” this revalidation effort in order to streamline the process by improving the PECOS online registration system prior to revalidating all Medicare providers.  According to the Medical Society of Virginia’s website (http://www.msv.org/MainMenuCategories/MemberCenter/PressRoom/News/2011-Archives/Revalidation-effort-delayed–.aspx):

In order to comply with the program integrity screening provisions of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) launched an effort to revalidate the enrollment of every provider and supplier by March 23, 2013. This effort has now been pushed back to 2015. Physicians will be among the last to revalidate.
 
In addition to pushing back the revalidation efforts, CMS made improvements to the online Medicare Provider Enrollment, Chain and Ownership (PECOS) system, which include:

• E-signatures
• Electronic document upload
• Batch upload capability
• Seamless password reset
• Enhancements for authorized officials
• Reassignment reports
• New “my enrollments page” and “fast track view” screens
• Fewer duplicative document submission requirements

CMS stated that the PECOS improvements will be implemented before most physicians are asked to revalidate.