Home Health & Hospice Week

Hint: The language you use on the official notice cannot be open ended.

Home health agencies are struggling  through the first month of mandatory use of the revised home health advance beneficiary notice (HHABN)--but not without a little coaching from the feds along the way.

Change Request 5009--dated Aug. 11 and available on the HHABN Web page--is the go-to official guidance on using the new form, a spokesperson for the Centers for Medicare & Medicaid Services tells Eli. But informally, the agency is still fielding questions from home health agencies and industry representatives in ways that are mapping out the path to compliance.

Tripping point: From the start of the phase-in for the new HHABNs, agencies have been confused about how the "ranges" common to plans of care and physician orders mesh with the world of HHABNs, notes Robert Markette with Gilliland Markette & Milligan in Indianapolis.

In an informal, CMS-issued "question and answer" document obtained by Eli, the agency clarified its position this month. "As we have said before, the instructions around use of ranges on the physician orders and the POC have not changed," states CMS in the Q&A.

So HHAs are free to use the ranges in visits, supplies or services as they always have in plans of care and on physicians' orders. The trick is using that information in a way the lightens the HHABN burden while complying with CMS' firm directive that "the use of ranges is not permitted on the HHABN"

Here's how: You cannot simply lift ranges as stated from physician orders or the POC and put them verbatim onto the HHABN. But you can use ranges noted on the plan of care and physician orders to help you manage the HHABN burden.

Tip: Think about the HHABN from the perspective of the patient, suggests a CMS spokesperson: "If an order or plan of care is written in a range, what does a patient need to know to understand how many times per week they can expect to see their HHA?"

Reduce Burden With The Right Wording

In the informal Q&A, CMS offers HHAs two ways to translate ranges in the POC or physician's orders into terms acceptable on HHABNs:

1. An agency can discuss a specific plan with the patient in terms that don't use ranges. For example, the agency can say, "We will visit 5 times per week for one week, 4 times per week for one week and 3 times per week for one week."

"This conversation should be documented," says CMS in the document.

Result: If care proceeds according to this plan, you won't have to issue new HHABNs when the reductions occur.

2. Alternately, an HHA can choose the specific frequency from the range that best meets the patient's needs at that time (e.g., 5 times per week), using that specific on the HHABN. The HHA would tell the patient that the agency staffer will be coming 5 times per week for the first week, and document the conversation, says CMS.

Drawback: In scenario number-two, the agency must issue subsequent HHABNs each time the frequency of the visits is reduced.

Key to compliance: Remember that the language you use on the HHABN cannot be open-ended regarding when a specific change described would occur.

For more guidance: If you have a question about how to use the HHABN, don't search the CMS site for the Question and Answer documents from this summer about the new HHABNs.  Instead, reread CR 5009 and contact your Regional Home Health Intermediary for guidance.

To find their number, go to www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip.

You can also ask questions related to HHABN compliance at the regularly scheduled Home Health, Hospice, and Durable Medical Equipment Open Door Forums. CMS cancelled the forum scheduled for September but has said that it will schedule one soon, probably for mid-October.

Note: To access Change Request 5009, go to www.cms.hhs.gov/BNI/03_HHABN.asp and click on the third link, CMS Manual HHABN Instructions.