Home Health & Hospice Week

Hold the phone on ABNs and ignore the NEMB altogether.

One of the biggest gray areas regarding the new expedited review notices is how they'll coordinate with ABNs - but don't expect guidance on that quandary any time soon.

The Centers for Medicare & Medicaid Services does give some clues on the differences between the new notices and the home health advance beneficiary notice in a new 45 Question and Answer set. "Expedited determination notices are given to alert beneficiaries, prior to discharge, of their right to obtain an independent, immediate review [of] the upcoming end of Medicare covered care from the HHA," CMS explains in Q&A 42.

"The HHABN is given before the delivery of potentially non-covered care, so that the beneficiary can make an informed choice as to whether or not to assume the responsibility for payment," CMS continues. "The HHABN informs beneficiaries that they may be required to pay for care the HHA believes Medicare will not cover. The HHABN will no longer be used to notify beneficiaries of the end of Medicare-covered care rather, the HHA should use expedited determination notices for that purpose."

But during the June 20 special Open Door Forum, CMS officials warned home health agencies not to adopt these new ABN guidelines and the recently proposed forms yet (see Eli's HCW, Vol. XIV, No. 18).

CMS offered contradictory advice in the forum. On one hand, officials said expedited review notices replace ABNs when a beneficiary's Medicare-covered services end. On the other hand, they said agencies should not change anything they're currently doing regarding ABNs, pending finalization of the new forms and rules.

"This just isn't ready for implementation," charges Burtonsville, MD-based attorney Elizabeth Hogue. "There are too many unanswered questions."

The relationship between the new expedited review notices and the HHABN is one of the "most problematic" issues regarding the new requirements, Tony Culotta, director of CMS' Medicare Enrollment and Appeals, admitted in the forum. CMS wants to iron out some problems before it finalizes the new ABNs, so it won't make the July 1 start date.

HHAs Blast Lack of Education

Heads up: HHAs don't have to worry about the aborted Notice of Exclusions from Medicare Benefits (NEMB-HHA). Even though the NEMB is listed on the CMS Web page for beneficiary notices, it is not in effect, CMS officials stressed in the forum.

With the revised ABN coming online, the NEMB likely will never see the light of day (see Eli's HCW, Vol. XIV, No. 19). It's "a dinosaur," Culotta noted.

Multiple callers said they thought the NEMB and ABN were going into effect along with the new expedited review notices. One administrator of a San Diego-area agency tells Eli she also was under this impression. "How are we supposed to know?" she asks.

HHAs are disappointed with the lack of education CMS, the intermediaries and many Quality Improvement Organizations have offered on the new notices, numerous agencies tell Eli. In many states, QIOs hadn't contacted providers at all by press time.