Home Health & Hospice Week

Take your opportunity to comment on the new ABN form for suppliers and hospices.

If the general Advance Beneficiary Notice form confuses beneficiaries now, just wait until the new version debuts soon.

The Centers for Medicare & Medicaid Services proposed a new version of the general ABN form in the Feb. 23 Federal Register. The new form, which will affect durable medical equipment suppliers and hospices, includes information about the beneficiary's right to demand that the provider bill Medicare for a service before paying out-of-pocket. (Home health agencies now use a separate, home health-specific ABN, not the general form.)

The new general ABN lets the patient choose among three options, instead of just two:
1) Don't provide the service
2) Provide the service and let the patient pay out-of-pocket
3) Provide the service and bill Medicare first.

Give ABNs A Test Run

Clarification: Patients always have had the right to insist that you bill Medicare and receive a denial before billing them out-of-pocket, but the form didn't make this clear before, notes Joan Adler with Adler Advisory Services in Atlanta, GA.

These changes will make it harder for you to say, "Medicare probably won't pay for it. We'll take a check now," says Jeff Fulkerson with Emory Radiology in Atlanta. "It gives the patient a little more authority in an ABN situation." The beneficiary can demand that you prove Medicare won't pay for something.

Tip: If patients are raising questions about the ABN form, try having a "mock registration session," Fulkerson advises. Have your manager act as the registration person and employees act as the beneficiary. Then employees can run the questions that patients ask past the manager and prepare themselves for possible situations that may arise.

Bottom line: Make sure beneficiaries understand that "Medicare doesn't pay for everything," Fulkerson. Just because they have the right to request you bill Medicare, doesn't mean Medicare will pay.

Don't Overuse Notices

Rule of thumb: Confused about when to use the notices? If you're providing ABNs to 1 percent of your patients, you probably don't have a problem. But if you're providing them to 10 percent of beneficiaries, then you're above average, Fulkerson says.

If you're receiving a lot of denials for a particular item or service, you need to figure out what's going on and possibly appeal, says Fulkerson. Don't just start issuing ABNs every time you perform that service or furnish that item.

Bottom line: "ABNs should be the exception rather than the rule," says Adler.

Give Your Two Cents

You should definitely comment on the proposed form during the 60-day comment period, advises Guadalupita, NM consultant Melanie Witt. Go to www.access.gpo.gov/su_docs/fedreg/a070223c.html and scroll down to the "8167--8168 [E7--3026]" entry under the CMS heading.

To obtain copies of the new general ABN for hospices and suppliers and supporting documents, go to www.cms.hhs.gov/PaperworkReductionActof1995.