Home Health & Hospice Week

Confusion abounds for notice application.

If you're finding it hard to understand and implement home health advance beneficiary notice procedures, you're not alone.

Home health agencies are stumped by HHABN scenarios time and time again, industry veterans report. That's even though months have passed since the Sept. 1 implementation date for the revised notices.

"Some staff still don't have the basics down pat," notes Burtonsville, MD-based health care attorney Elizabeth Hogue.

HHAs "are still feeling overwhelmed" more than three months into the new requirement, says consultant Judy Adams with LarsonAllen based in Charlotte, NC.

"Many providers struggle with the cumbersome instructions and interpretations for the HHABN," notes consultant Laura Gramenelles with Simione Consultants based in Hamden, CT. "It is difficult to learn all the nuances."

Providers are finding it hard to comply with ABN rules when those rules are "muddy," says attorney Robert Markette, Jr. with Gilliland, Markette & Milligan in Indianapolis. Markette blames unclear instructions for the confusion.

Clients of consultant Pam Warmack with Clinic Connections in Ruston, LA are struggling with ABN application, she tells Eli. "Between the HHABN and Expedited Review Notices, the clinicians are continually scratching their heads to determine what [the Centers for Medicare & Medicaid Services] expects of them."

Staff Education Not Cutting It

A main ABN problem: Agency management are having problems getting staff to implement the notices correctly. Some managers "are very frustrated because field staff just aren't complying with the requirements," despite new policies and procedures and appropriate education, Hogue relates. Some staff "are not even making an effort to comply because they really don't understand."

HHA executives find it difficult to learn the ins and outs of the HHABNs themselves, let alone teach it to field staff and make sure they are able to deliver the HHABN correctly, Gramenelles says.

Staff are finding it hard to understand when to use the ABN, particularly regarding reductions in care and physicians' orders, experts say. Confusion between expedited review notices and ABNs is another common problem.

Make A Good Faith Effort

Agencies won't get in trouble for furnishing an ABN when it wasn't necessary, but authorities could find them out of compliance for not giving an ABN when it was required, Markette notes. With that in the mind, agencies could decide to furnish the notices whenever there is a possibility that it may be necessary.

Not so fast: But providers also have to be practical and keep their unnecessary costs down, Markette points out. That means limiting ABN issuances to those that are mandatory.

And agencies haven't seen a big regulatory crackdown on the ABN issue yet, Markette points out. "No one is getting cited."

At this point, it appears that as long as you are making a good faith effort to issue notices when they're required, you probably won't get dinged on your survey, Markette observes. Once surveyors start enforcing ABN requirements more strictly, agencies may have to tighten up their own policies and procedures regarding the notices, he expects.

Keep an eye out: Markette is hoping for further guidance on ABNs, perhaps via more Q&As, from CMS. "We've gone three months with no additional guidance," he points out.