New ABN Form

CMS released a new ABN form effective 1/1/2021. The form itself looks very similar to previous versions. The documentation includes 26 pages of changes.

IMS is highlighting the section regarding optional use of the ABN for non covered services. For chiropractic this refers to all therapies performed by a chiropractor with the exception of chiropractic manipulation therapy (CMT).

Previously we would advise our chiropractic clients to include a notice similar to an ABN that informs the patient that only CMT is covered and any additional treatments would have to be paid out of pocket.

The new instructions state “CMS strongly encourages healthcare providers and suppliers to issue the ABN for care that is never covered.”

Certainly something to consider and may perhaps help alleviate the confusion around when an ABN is required and when it is only optional.

Original Medicare Beneficiary Liability Notice

The new ABN form and instructions can be found here: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN

Emergency Medical Condition (EMC)

EMC – Emergency Medical Condition – Personal injury benefits can be suspended at $2500 if an Emergency Medical Condition (EMC) is not declared by a qualified provider.

Here is the quote from the Statute:

Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced practice registered nurse licensed under chapter 464 has determined that the injured person had an emergency medical condition.

http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.736.html

Furthermore, in order to ensure the EMC is accepted by the payor it is suggested to have the following wording in the EMC soap notes:

“It is my professional medical opinion that the patient suffered an EMERGENCY MEDICAL CONDITION per
Florida state law HB119. The basis of this opinion for the finding of an EMERGENCY MEDICAL
CONDITION is that the patient has sustained acute symptoms of sufficient severity, which may include severe
pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the
following: a) serious jeopardy to patient health; b) serious impairment to bodily functions; or c) serious
dysfunction of a bodily organ or part.”

Ideally a provider will make sure the proper documentation is in place if an EMC has been declared.

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