Home Health & Hospice Week

If you haven't started using the new advance beneficiary notice form for hospice and durable medical equipment, don't worry -- you've still got months to comply.

The Centers for Medicare & Medicaid Services allowed providers to start using the new ABN-G (CMS R-131) in March and set a deadline of Sept. 1 for a complete switch-over to the new form (see Eli's HCW, Vol. XVII, No. 19, p. 146). But then in a new memo, CMS bumps that deadline to March 1, 2009.

"Beginning March 1, 2009, Contractors shall accept only a properly executed revised ABN (CMS R-131) as valid notification," CMS says in Sept. 5 Transmittal No. 1587 (CR 6136).

"After that date, forms ABN-G and ABN-L will not be accepted," the Connecticut Association for Home Care & Hospice warns in its newsletter for members.

The new 49-page memo includes additional instructions in the online-only Medicare Claims Processing Manual, with special sections for DME and hospice notices.

For example: "ABNs cannot be used to charge beneficiaries for premium quality services described as 'excess components,'" CMS says in the manual's new DME instructions. "Similarly, ABNs cannot be used to shift liability for an item or service that is described on the ABN as being 'better' or 'higher quality.'"

Hospices may not have as many problems with the new form as other providers. "The ABN will likely be given less frequently for the hospice benefit than in other settings," CMS acknowledges.

CMS says the three situations that would require issuance of the ABN to a hospice patient are:

• Ineligibility because the beneficiary is not terminally ill;

• Specific items or services that are billed separately from the hospice payment, such as physician services, are not reasonable and necessary; or

• The level of hospice care is determined to be not reasonable or medically necessary, specifically for the management of the terminal illness and/or related conditions.

Note: The transmittal is at www.cms.hhs.gov/transmittals/downloads/R1587CP.pdf.