Home Health & Hospice Week

If you think you know how to deal with ABNs related to Part B therapy caps, think again. The difference between a "recommended" advance beneficiary notice and a "required" one could cost you thousands of dollars if you furnish Part B therapy in patients’ homes.

Background: Earlier this year, if you provided Part B outpatient therapy services to a patient who had exceeded the therapy cap, the beneficiary was automatically responsible for the non-covered services, and CMS had encouraged therapy pro-viders to issue a voluntary ABN as a courtesy, even though it wasn’t required. (Reminder: Medicare therapy caps apply only to Part B services, not to therapy furnished under a home health plan of care.)

Fast forward to Sept. 6, when CMS issued MLN Matters article MM8404, which states that this rule has changed. "Now, the provider/supplier must issue a valid, mandatory ABN to the beneficiary before providing services above the cap when the therapy coverage exceptions process isn’t applicable," the article advises. "ABN issuance allows the provider to charge the beneficiary if Medicare doesn’t pay. If the ABN isn’t issued when it is required and Medicare doesn’t pay the claim, the provider/ supplier will be liable for the charges."

Of course, as in the past, if you are providing therapy services that aren’t reasonable and necessary, you must have the patient sign an ABN, regardless of the patient’s status with the Part B therapy cap.

To read the complete article, which includes examples of phrases you can use in a therapy cap-related ABN, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8404.pdf.