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Wednesday, September 7, 2011

NEW Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131(03/11)

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, 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.

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