Home Health & Hospice Week

Know when to hand off ABNs to frontline staff--and when not to.

It's crunch time for home health agencies implementing home health advance beneficiary notices, with the June 1 due date looming large.

The National Association for Home Care & Hospice dispensed practical advice on getting up to speed on the new ABNs in a May 9 teleconference.

"The kindest way to put it is that the ABN is a burden" for HHAs, William Dombi, vice president for law with NAHC's Center for Health Care Law, noted in the conference.

"It just seems like there could be an easier way," laments Beverly Kelley, Georgia regional director of operations for Guardian Home Care. While keeping patients informed of changes is good, the ABN is an overly complicated--and possibly ineffective--way to do it, Kelley tells Eli.

Watch out: And ABNs seem to get more complicated by the day. HHAs that were relieved to see the Centers for Medicare & Medicaid Services restrict HHABNs to home care services only in a recent question-and-answer set will be disappointed that CMS is backtracking on that exemption.

CMS told agencies "the revised HHABN in-structions do not apply to services outside the home health benefit, such as when HHAs are acting as [durable medical equipment] suppliers, or possibly administering therapy plans of care to non-homebound beneficiaries," according to Q&A #20 of its recently released 25-question set on the new ABNs (see Eli's HCW, Vol. XV, No. 18).

But CMS has told NAHC it made a mistake in that answer and will correct it soon. "In fact, the HHABN is required" for DME and outpatient therapy, NAHC's Mary St. Pierre instructed listeners.

Other guidance NAHC offered in the teleconference included: • Who makes the ABN call. While HHAs are ironing out their ABN policies and procedures, they should consider one important wrinkle, St. Pierre urged--who completes the ABN when physician orders disagree with the change in care.

Agencies generally can train their visiting staff to accurately determine when ABNs are necessary and fill out the notices when a physician orders the change, she advised. But when the care plan change goes against physician orders and the beneficiary may appeal, agency management should take over and decide when to issue and how to fill out the ABN, she urged. That's because the agency could end up being financially liable for the patient's care.

Try this: Providers also should have management approve ABNs that use Option Box 2, where the agency decides to reduce or terminate services for its own financial or business reasons, rather than Option Box 1, which applies to non-coverage situations, St. Pierre counseled. • Physician orders. When the physician orders a reduction or termination in care that wasn't on the original plan of care, HHAs must [...]