NEW Advance Beneficiary Notice of Non-Coverage (ABN)
The centers for Medicare and Medicaid Services (CMS) has released a revised Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131 form, http://www.cms.gov/BNI/02_ABN.asp. The ABN is issued by providers where, depending upon a situation, Medicare payment is expected to be denied. That includes a covered service in which the doctor believes Medicare will not pay and all non-covered services billed to Medicare.
That also includes referral of a Medicare patient for any service by another health care provider including a covered service.
NOTE: The only differences found on this revised ABN and the prior is the date of issue on the bottom of the form. CMS-R-131(03/11)
This specific form has a mandatory use date of November 1, 2011.
Option # 2 is the primary change from the original ABN. Please keep in mind, Option #2 is used ONLY for non-covered service. Taking a covered service as 98940, 98941 or 98942, calling it maintenance care, with the patient checking Option #2 and not billing the Medicare Carrier for the Chiropractic adjustment is "thin ice" maneuvering.
The Chiropractic adjustment is the only reimbursable service for Chiropractors. When a Chiropractor adjusts a patient to correct a vertebral subluxation, then that is a covered service in Medicare not maintenance care.
The doctor must learn to honestly and specifically "document" the Chiropractic necessity of care by "federal standards." The patient who has a subluxation has had either an accident, exacerbation, or a specific "Neuronal Component". It is the doctors job to prove the subluxation, document the cause of subluxation, and correct the subluxation with an adjustment. That is a covered service by Medicare.