Home Health & Hospice Week

Grace period for CMS' updated, revised ABN ends Sept. 1.

If you still struggle with understanding the difference between the ABN and the NEMB forms for durable medical equipment and hospice services, your prayers have been answered.

In March, the Centers for Medicare & Medicaid Services unveiled its new advance beneficiary notice. The new form replaces both the previous ABN-G (for DME suppliers, hospices, part B therapy and other providers like physicians) and ABN-L (for laboratories) and incorporates the notice of exc-lusions from Medicare benefits (NEMB) form. CMS expects this new, combined ABN form to "eliminate any widespread need for the NEMB in voluntary notification situations," according to the new ABN Form Instructions document.

Then: In case you weren't familiar with exactly when you were supposed to use the ABN rather than the NEMB, keep in mind that in the past, ABNs were only for equipment or services that Medicare might not cover but didn't apply to items or services that were statutorily excluded from Medicare benefits. That was where the NEMB came in--you were able to use it for services such as therapy services beyond the Part B therapy caps (that didn't fall under an exception) because Medicare never covered them.

Now: CMS will accept the new ABN form for either purpose, noting in its ABN Instructions that "the revised version of the ABN may also be used to provide voluntary notification of financial liability."

Don't worry: Although Medicare contractors began accepting the new ABN form on March 3, CMS has implemented a six-month transition period. Therefore, you aren't required to submit the new form until Sept. 1.

New ABN Importance Emerges

DME suppliers should be especially aware of the new ABNs, CMS urges in a recent email to providers.

Competitive bidding will make these documents crucial for non-contract suppliers, the agency expects. "Given the range of situations wherein Medicare may or may not pay for a specific item of DMEPOS, it is imperative that non-contract suppliers understand the significance of issuing or not issuing an ABN to beneficiaries to whom they are furnishing a competitively bid item," CMS says in the message.

In other words, if your patient wants to stick with you under bidding, even though you're not a contract supplier, he or she must agree to pay privately for the equipment. But you can't collect the money from the beneficiary unless she has signed a valid ABN.

Exception: Home health agencies don't have to worry about the new ABN-G forms. They use their own separate home health ABN form. 

Note: The new ABN and instructions, in-cluding a Spanish-language form, are at www.cms.hhs.gov/BNI/02_ABNGABNL.asp.

More information about using ABNs under bidding is in a recent MLN Matters Article online at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf.