Home Health & Hospice Week

Start training your staff ASAP, expert says.

Home health agencies won’t enjoy their reprieve from the new home health advance beneficiary notices too much longer.

The Centers for Medicare & Medicaid Services issued a revised ABN with a notice in the June 23 Federal Register. CMS will require HHAs to use the new ABN by Sept.1, the agency says in new instructions.

But CMS encourages providers to use the new ABN even before the deadline. “We urge [HHAs] to begin using the new form on July 1, 2006, or as soon as possible after that date,” the instructions say.

Tip: Between July 1 and Sept. 1, HHAs can use either the old or new notice and still be in compliance.

The revised forms and instructions come on the heels of litigation from The Center for Medicare Advocacy, the advocates representing the beneficiaries in the lawsuit that sparked the new ABNs. The Center asked a Connecticut federal court to require CMS and providers to use the formerly proposed HHABN by July 1 (see Eli’s HCW, Vol. XV, No. 23).

On hold: The government countered that request with a filing asking the court to give the feds until August to respond to the request, explains CMA attorney Gill Deford.

For CMS, having a firm deadline set for the ABN should help sway the court to its side, expects attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. Also, arguments that providers are entitled to other rights under federal law, namely the right to comment on the new forms under the Paperwork Reduction Act, may be persuasive.

But beneficiaries don’t trust CMS to stick to its ABN deadline of Sept. 1, Deford tells Eli. The agency has failed to hit numerous deadlines along the ABN journey. “Maybe they’ll comply with it, maybe they won’t,” he observes.

That means more litigation in the case could be ahead, depending on the ABN status, Deford confirms.

Forecast: But providers can expect the Sept. 1 ABN deadline to stick this time around, unlike the June 1 deadline that CMS postponed at the last minute, Markette predicts.

That’s despite the widespread confusion still surrounding the new forms, notes Burtonsville, MD-based health care attorney Elizabeth Hogue. “There are major issues that are still not clear such as when the new HHABN is to be used and when to use various options,” Hogue says. “In other words, the basics.”

Doubts linger: And the list of unsettled questions continues. For example, agencies want firmer details on when ABNs apply when the physician orders a range of visits; when ABNs are required for recertification episodes; and when to use ABNs when one discipline finishes earlier than the others in a case, says consultant Judy Adams with LarsonAllen in Charlotte, NC.

HHAs Better Prepared This Time Around

Providers can expect their paperwork burden to increase substantially when the new ABN requirement hits, Markette warns. But many agencies may be better prepared because they revamped policies and procedures and trained staff on the forms already leading up to the postponed June 1 deadline.

Some HHAs already adopted the formerly proposed ABNs and stuck with them because they had made the transition before CMS called off the last deadline, Markette adds. Because the new forms make only minor changes, most notably the addition of the third option box for doctors’ orders, those agencies will see little change, he notes.

Don’t fall for it: CMS encourages agencies to adopt the new ABNs as soon as possible, but providers have no incentive to do so, Markette observes. He urges agencies to use the time up to the deadline to train staff on the changes and prepare fully for the transition.

And agencies should use the new comment period CMS offers in the June 23 Federal Register to sound off about the problems with ABNs, Hogue adds.

“Providers should send all of their questions and concerns to CMS right away,” she urges. “The number of comments submitted the last time around did seem to make a difference--it was the basis for CMS’ decision to delay implementation.” The new comment period closes July 24.

Note: The Federal Register notice with instructions on how to submit comments is at www.access.gpo.gov/su_docs/fedreg/a060623c.html  --scroll down to the 36097--36098 entry under CMS.

For copies of the new HHABN forms and instructions, email executive editor Rebecca Johnson at rebeccaj@eliresearch.com with “Revised ABN” in the subject line.

For more information on the new ABNs, attend Robert Markette Jr.’s ABN audioconference Aug. 15 presented by Eli Research. You can sign up at www.audioeducator.com/industry_conference.php?id=62 or by calling 1-800-508-2582.