Home Health & Hospice Week

 6 tips for ABN success now that the two-page form is obsolete.

More than two years after it was proposed, Medicare's one-page advance beneficiary notice has become mandatory for home health agencies. That means if HHAs fail to use the newly required form, they could have to furnish services for free to patients whose care they believe Medicare won't cover. And they could be found in violation of the conditions of participation as well. Since the Office of Management and Budget approved the one-page ABN (CMS-R-296) in June 2002, agencies have been able to use either the new form or the old two-page ABN and still protect their ability to bill the patient if Medicare didn't cover services, and be in compliance with the COPs (see Eli's HCW, Vol. XI, No. 22, p. 174). But now agencies must use the new form only, say new instructions in the Medicare Claims Processing Manual (Pub. 100-4). Medicare switched from using the HIM 11 manual to the new Internet-Only Manuals (IOMs) last fall (see Eli's HCW, Vol. XII, No. 33, p. 262). When the Centers for Medicare & Medicaid Services first proposed the new ABN, there was much outcry from providers, recalls William Dombi, vice president for law with the National Association for Home Care and Hospice's Center for Health Care Law. Complaints about the form included: required demand billing for patients dually eligible for Medicare and Medicaid home care services; the requirement for agencies to write in a three-line blank the reason for Medicare's expected denial of services; and confusion on exactly when to issue the notice. But HHAs appear to have settled into distribution of ABNs with few reported problems. "People have accepted the necessary nuisance" of furnishing the notices, Dombi says. However, some of the reason agencies have reported few problems might be because they aren't issuing the notices as required by regulations, Dombi worries. Agencies should follow these points from the manual instructions to ensure they are in compliance with ABN requirements, and thus protecting their COP status and their ability to bill patients for services denied by Medicare: 1. Issue ABNs for physician-ordered services only. If a physician agrees that Medicare won't cover services and changes her orders for home care, agencies don't have to issue a notice to the patient. HHAs must document the order change. But if a physician orders services an agency doesn't think Medicare will cover and she sticks by the order, the agency should furnish an ABN with an explanation of its reasoning to the patient. 2. Issue ABNs upon "triggering events" only. The manual defines triggering events as one of three changes to service: initiation, reduction or termination. Agencies also must re-issue [...]