E/M Coding Alert - 2008 Issue 10
PART B REVENUE BOOSTER: New ABN May Cut Need for NEMB
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Article Overview
This article covers CMS’s revised advance beneficiary notice process and how it affects Medicare patient notification for potentially noncovered or excluded services. It is aimed at billing staff, coders, and compliance-focused practices that need to understand the new combined notice form, the transition period, and the general modifier context that accompanies denied or excluded services. The discussion also highlights why the change matters for office workflows, patient communication, and claim handling under Medicare Part B.
Why This Topic Matters
The updated notice form changes how practices document financial liability discussions and reduce reliance on separate exclusion notices. Understanding the transition period and related claim-notification workflow helps offices avoid preventable billing and patient-liability problems.
Article Sections
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CMS updates to the ABN and NEMB process
Overview of the revised notice form and the shift in Medicare notification procedures. Covers the broad reason the update matters for practices that handle potentially noncovered or excluded services.
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Transition period and implementation timing
Discusses the effective date, the temporary transition window, and when the revised notice is expected to be used. Focuses on timing and administrative adoption rather than coding details.
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Three ABN tips
Summarizes general best practices for using beneficiary notices in the office setting. Addresses patient communication, documentation, and claim-processing considerations at a high level.
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Modifiers and ABN status
Explains the general relationship between claim modifiers and beneficiary notice status. Reviews the broader circumstances in which different modifier choices may be relevant for Medicare billing workflows.
What You Will Learn
- How CMS revised the beneficiary notice process
- Why the new form affects handling of noncovered and excluded services
- What the transition period means for office procedures
- How patient communication fits into beneficiary notice workflows
- How modifier selection relates to notice status at a general level
Who Should Read This
- Medical billers
- Coders
- Practice managers
- Compliance staff
- Physician office staff
- Laboratory billing staff
Modifiers Discussed
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