Home Health & Hospice Week

Home health agencies now have further guidance on completing ABNs for patients dually eligible for Medicare and Medicaid.

"When issuing ABNs to dual eligibles or beneficiaries having a secondary insurer, HHAs are permitted to direct the beneficiary to select a particular option box on the notice to facilitate coverage by another payer," CMS says in a new MLN Matters article related to CR 8597, which provides corrections and clarifications to the Advanced Beneficiary Notice (ABN) instructions in the Claims Processing Manual. "This is an exception to the usual ABN issuance guidelines prohibiting the notifier from selecting one of the options for the beneficiary."

What to do: "When a Medicare claim de-nial is necessary to facilitate payment by Medicaid or a secondary insurer, HHAs should instruct beneficiaries to select Option 1 on the ABN. HHAs may add a statement in the ‘Additional Information’ section to help a dual eligible better understand the payment situation such as, ‘We will submit a claim for this care with your other insurance,’ or ‘Your Medi-cal Assistance plan will pay for this care,’" CMS says in the MLN Matters article.

Plus: "HHAs may also use the ‘Additional Information’ on the ABN to include agency specific information on secondary insurance claims or a blank line for the beneficiary to insert secondary insurance information," CMS adds. "Agencies can pre-print language in the ‘Additional Information’ section of the notice."

The article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8597.pdf.