Posts Tagged ‘ABN’

CMS Issued A Vaccine Update 3/21/13

In Uncategorized on August 23, 2013 at 5:57 pm

Recall my discussion in a prior post of CMS’ refusal to cover tetanus (or other vaccines, other than the annual influenza vaccine, the once per lifetime pneumococcal vaccine, and the high-risk patient’s hepatitis-B vaccine) as a medically necessary vaccination absent an incident of exposure?  Well, in spring of 2013, CMS clarified their position.

To report the tetanus vaccine administered for the treatment of an injury or direct exposure to a disease or condition, append modifier AT (acute treatment) to the code for the vaccine.  Claims submitted without modifier AT will be denied.

 Note: The medical record must support the need for the service and the use of modifier AT.

Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.  See, The Centers for Medicare and Medicaid Services Benefit Policy Manual, 100-02, Chapter 15, Section

Remember, patients demanding a vaccine absesnt an acute incident or exposure need to be presented with and execute a valid Advanced Beneficiary Notice (ABN) in order for the practice to be able to bill that patient once Medicare denies the claim.


Resolve To Use The New CMS ABN In 2012!

In Uncategorized on December 21, 2011 at 4:52 pm

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: 

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.