Medicare Compliance & Reimbursement

You still have to issue an ABN if the reduction is included in the recent plan of care.

Get ready to crank out even more home health advance beneficiary notices than you expected come June 1.

The Centers for Medicare & Medicaid Services has issued 25 new questions and answers on the troublesome subject of ABNs, and home health agencies aren't happy with many of the new clarifications.

"The HHABN regulations are unbelievably complex and absolutely overboard," blasts Lynda Laff, chief operating officer with Island Health Care based in Savannah, GA.

ABN rules are "horribly complicated," criticizes Chicago-based regulatory consultant Rebecca Friedman Zuber. Instead of facilitating a dialog between HHAs and patients, the new ABN "clutters up communication."

"CMS has told us to flood the beneficiaries with notices and we just have to figure out the most efficient way to do so," laments Bob Wardwell with the Visiting Nurse Associations of America.

Warning: "Creating a level of notice requirements that is this overwhelming invites non-compliance," adds Wardwell, a former top CMS official. Recert ABN Workload Increases One big surprise for many HHAs: CMS' direction to issue ABNs for service reductions that are included on the plans of care for subsequent recertification episodes. "If reductions occur at the time of recertification, the HHA should convey that information with an HHABN," CMS instructs in Q&A #10.

Even if the reductions happen after the recert episode begins, agencies still must issue an ABN at some point. "If reductions are expected on the plan of care over the next 60 days, the HHA can choose to convey that information to the beneficiary using an HHABN at the time of recertification," CMS explains. "In this case, no further HHABN would be needed when those reductions occurred as anticipated."

In other words, if services continue as usual for a week or two into the second episode, then drop as outlined in the recert plan of care, agencies have two options, explains attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. Option one is to issue the ABN at recert time. Option two is to issue the ABN when the service reduction actually takes place.

Take heed: But no matter what, the agency must issue an ABN for a service reduction, even if it is on the recert plan of care, Markette emphasizes. Only service reductions included on the original, first episode POC are exempt from ABNs, he advises.

"This is a new twist that many may not have interpreted with the original instructions," judges consultant Judy Adams with Charlotte, NC-based Larson-Allen. "With this clarification, even when there are written MD orders in advance of reducing the services for a new episode, the agency will have to do an HHABN."

It's "ridiculous" to issue an ABN [...]