Home Health & Hospice Week

CMS issues new questions and answers on ABN details.

You may have overlooked an important item on your home health advance beneficiary notices--and it could land you in hot water with surveyors.

Both surveyors and regional home health intermediaries will be reviewing ABNs, the Centers for Medicare & Medicaid Services warns in its supporting statement for the new forms issued June 23. Surveyors will check for Medicare condition of participation compliance while RHHIs will check for agency financial liability.

CMS clarifies how ABNs apply to supplies furnished to home health patients in a new set of questions and answers issued with the revised ABN forms and instructions.

Do this: Home health agencies should include a "general description" of patients' supplies on the ABN, CMS instructs in one question. For example, "wound care supplies" would be sufficient and an itemized list isn't required, the Q&A says.

But when a supplies reduction occurs, agencies must include enough information so that the patient understands what's being reduced, CMS says. For example, saying you will furnish wound care supplies monthly instead of weekly would be OK.

Supplies Reductions Stand Alone

HHAs should issue an ABN describing supplies reductions even if the supplies are the only things being cut, CMS explains in another Q&A. For instance, if the physician reduces the patient's self-administered wound care from twice a day to once a day, the agency needs to issue the patient an ABN outlining the corresponding reduction in supplies, CMS says.

Exception: Agencies do not, however, have to use ABNs for supplies that aren't covered under the home health benefit and paid for under the prospective payment system, CMS says in another Q&A. "Issue HHABNs only for services that you are billing or rendering, not items or services that beneficiaries may permissibly obtain from other sources while under your care," the agency instructs.

The set of Q&As on supplies may leave some providers scratching their heads, predicts attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. CMS' answers seem contradictory in some places--for example, not having to name supplies specifically, but having to list reductions in supplies. "Good luck navigating that one," Markette tells Eli.

In fact, HHAs may be frustrated with the lack of specificity in many of CMS' 26 new Q&As, Markette expects. "Providers want yes-or-no answers, but CMS answers vaguely" in some areas.

Providers may also be disappointed that CMS doesn't break more new ground in the Q&As. Many of the answers reinforce previous guidance and fail to address agencies' questions on the most confusing issues, judges consultant Judy Adams with Larson-Allen in Charlotte, NC. The answers also don't address the changes in the revised ABNs, Adams notes.

And one Q&A points to the unnecessary workload the ABNs entail, Markette adds. When a physician tells the patient her wound care will decrease, why does the HHA have to repeat the fact with an ABN, he asks.

Other issues addressed in the Q&As include:

• Pre-printed forms. CMS allowance of pre-printing on ABN forms may be wider than providers had expected. "HHAs may have multiple versions of the HHABN specialized to common treatment scenarios, using all the required language and formatting of the HHABN, but with pre-printed language in its blanks," the agency allows.

Agencies can use check-boxes for things like disciplines being reduced, but must include specifics on what's changing, CMS says. For example, checking a physical therapy box isn't enough; specifying that PT is reduced to twice per week is.

Pre-printing forms for different scenarios could increase efficiency and save time and money, Markette observes. But pre-printed forms could also become a liability risk if clinicians don't use them appropriately or if agencies don't format them properly to start with. CMS says it doesn't have the resources to individually approve agencies' pre-printed ABN forms.

Tough decision: Management will have to decide how much information an agency can pre-print and still avoid liability risk, Markette advises.

• Service increases. CMS confirms that agencies don't need to issue an ABN when services increase or are maintained at the same level. Only reductions in care required by plan of care changes trigger ABNs, the agency explains.

• Other payors. If you furnish non-Medicare-covered care to long-term patients, you can expect to issue them ABNs once a year, CMS reminds providers. For dually eligible beneficiaries, "HHABNs should be provided at least annually to alert beneficiaries that other payers--like Medicaid--are covering their care," CMS instructs.

• One-time visits. Requirements for one-time visits vary depending on who is financially liable, CMS explains. If you don't bill the beneficiary, no ABN is required. If you do bill the beneficiary, even if you aren't going to bill Medicare, you must issue an ABN. 

Note: The June 20 Q&As are at www.cms.hhs.gov/BNI/03_HHABN.asp --scroll down to the "Downloads" section.