Home Health & Hospice Week

You may have until March 2009 to implement the new advance beneficiary notice for hospice, but you should start working toward implementation well before that to ensure compliance.

Hospices may be tempted to put the new ABN form on the back burner since the Centers for Medicare & Medicaid Services bumped the deadline back from Sept. 1 to March 1 (see Eli's HCW, Vol. XVII, No. 33, p. 261). That's especially true because hospices issue ABNs less frequently than other providers, notes attorney Ross Lanzafame with Harter Secrest & Emery in Rochester, NY.

But falling behind on implementation could be a bad idea for your compliance standing and your bottom line, experts say, since issuing ABNs is often confusing for hospices. The fact that hospices furnish ABNs comparatively rarely probably makes the issue even more confusing due to lack of familiarity, cautions Judi Lund Person with the National Hos-pice and Palliative Care Organization.

Don't delay: Hospices "should start experimenting with it a little bit" if they haven't begun using the new CMS-R-131 already, Lund Person suggests. Then they can transition when they feel comfortable with the form, hopefully well in advance of the March deadline.

Hospices actually may benefit from switching to the new form, Lund Person tells Eli. The CMS-R-131 and its instructions are clearer than the old form and instructions.

Back to basics: Hospice providers should get to know the three main situations in which CMS requires an ABN for hospice patients, Lanza-fame says:

1. Ineligibility because the beneficiary is not "terminally ill" as defined by Medicare;

2. Specific items or services that are billed separately from the hospice payment, such as physician services, are not reasonable and medically necessary; or

3. The level of hospice care is determined to be not reasonable or medically necessary, specifically for the management of the terminal illness or related conditions.

Another one: And there's a fourth reason not specifically listed, NHPCO adds in a tip sheet for members -- the patient chooses to continue hospitalization after the hospice determines it is no longer medically necessary and chooses not to revoke the hospice benefit.

Hospices should also issue an ABN when the patient chooses to stay in a hospital that doesn't contract with the hospice, NHPCO adds. In both cases, the hospice may delegate delivery of the ABN to the hospital.

The new form and instructions may be more clear, but they'll still leave providers scratching their heads. One confusing issue is what to put in Column E, which is the "Reason Medicare May Not Pay."

CMS lists these common denial reasons to put in Column E, Lanzafame notes:

• ineligibility for the hospice benefit;

• the documentation submitted does not support that the illness is terminal;

• the service is not covered because it was provided by a non-attending physician;

• surgical removal of a cataract is not a hospice covered benefit; and

• this service is not covered because you (the patient) are enrolled in a hospice.

To ensure you are up and running by the March deadline, Lund Person recommends taking these three steps.

1. Decide who will be responsible for the ABN. "Identify where in the organization the ABN will live," Lund Person advises -- perhaps in the patient care department or the billing office. Make someone accountable for generating and delivering the forms correctly.

2. Work ABNs into your existing processes. "Every hospice has to figure out how to make that work as easily as possible," Lund Person says. Because ABNs aren't given out in large volumes, it shouldn't be a big burden for the responsible party. But it should be clear how to do it when they are necessary.

3. Update your policies and procedures. Your written P&Ps should match your new or re-vised ABN operations, Lund Person counsels.

Resource: The new form and instructions are at http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp. Hospices can send ABN questions to revisedabn_odf@cms.hhs.gov, a CMS rep said in the Sept. 17 Open Door Forum for home care.