Home Health & Hospice Week

But frequency ranges still controversial.

Home health agencies are looking for ways to ease the huge new paperwork burden posed by the new home health advance beneficiary notices--and with an extended due date they may have time to make some big changes.

One answer may be to use visit ranges on the initial plan of care instead of absolute visit numbers, experts suggest. In a recent question-and-answer set on the new ABNs, regional home health intermediary Cahaba GBA gives its blessing to using visit ranges to avoid unnecessary ABN issuances.

The question: "We ... use ranges on our CMS-485 per [Centers for Medicare & Medicaid Services] guidelines," one HHA tells the intermediary. The agency's staff decrease visits as the patient progresses and document in the clinical record the reason for the decrease. They also inform the patient of the reduction in visits and document that. "Is this enough documentation to avoid the use of the HHABN for reduction of services?" the agency asks.

The answer: "If the reduction of services is part of the initial plan of care (POC), an HHABN would not be required," Cahaba says. "However, if services are reduced beyond the range indicated in the POC, an HHABN would be required."

"We are recommending the same as Cahaba," says Mary St. Pierre with the National Association for Home Care & Hospice. If services decrease within the range listed on the initial plan of care, no HHABN is necessary, St. Pierre tells Eli.

"Ranges are perfectly appropriate if used properly," adds consultant Betty Gordon with Simione Consultants in Westborough, MA.

Visit Range Picture Is Blurry

But some skeptics aren't so sure visit ranges are the way to go.

First, regulators can argue that visit ranges don't give patients specific enough notices of reductions in care, worries consultant Judy Adams with Larson-Allen based in Charlotte, NC. The argument against visit ranges is that "if an HHA did not tell the patient which specific week services would be reduced, the beneficiary did not receive clear advance information and a HHABN would be needed," Adams says.

Second, some state surveyors make using visit ranges very difficult. Surveyors can expect agencies to stick only to the top of the visit range listed and cite them if they don't, Gordon warns. That's even though CMS has approved the use of visit ranges.

Adams hopes CMS will issue guidance that specifies how visit ranges and ABNs interact. Until then, there may be no clear-cut answer.

Providers should expect some weeks or even months of uncertainty until these gray areas get clarified, predicts attorney Robert Markette Jr. with Gilliland, Markette & Milligan in Indianapolis. That's especially true considering the extended deadline for the new ABNs.

Despite the concerns, proponents of visit ranges insist that using them appropriately is valid and even the most responsible course to take. HHAs "are being too conservative with those ranges," maintains Gene Tischer with trade group Associated Home Health Industries of Florida.

Agencies that don't use ranges and end up issuing even more ABNs are creating extra work for themselves, Tischer tells Eli. "I can't believe those administrators are going to put their staff through all that extra stuff when it's not necessary."

CMS has approved use of visit ranges, Tischer points out. And providing services within the ranges listed doesn't require any extra physician orders, let alone an ABN. Failing to use ranges is "absurd," he stresses.

Justified: HHAs can argue that "since the patient was notified that visits would decrease ... during the episode, they had advance notice and no HHABN should be needed," Adams points out. 

Note: Cahaba's ABN Q&As start on p. 43 of Cahaba's May Newsline at www.cahabagba.com/part_a/education_and_outreach/newsletter/0506_RHHI.pdf