Medicare Compliance & Reimbursement

Agencies hope for more clarity in ABN instructions.

It's official: You have at least three months' breathing room on the new home health advance beneficiary notice (HHABN).

Due to the high volume of comments received on the ABN's Paperwork Reduction Act notice, the Centers for Medicare & Medicaid Services "is extending the phase-in period for use of the new form through at least September 1, 2006," the agency said in a May 26 email to its home health Open Door Forum listserv.

"Home health agencies may continue to use either the traditional HHABN or the revised version of the form until further notice," CMS stresses in the message. The agency hopes to announce a finalized deadline as soon as possible, it says.

"I am delighted to see that CMS recognizes the massive burden the HHABN has placed on our staff and has elected to put things on hold," cheers Marcia Tetterton with the Virginia Association for Home Care.

Confusion reigns: HHAs sorely needed the delay due to the confusion about the new form and instructions, says Mary Schantz with the Missouri Alliance for Home Care. If the "nurses who will be in the homes of patients explaining this new requirement don't fully understand the policy, process and reasons, it will just be confusing to patients and families," Schantz tells Eli. That adds to a lot of confusing rules, regulations and paperwork patients have already, she adds.

The delay was a real necessity, many providers say. "Everyone I talked to didn't have a clue" about the ins and outs of the new ABN, says Marilyn Danzy with New Vision Home Health Agency in Los Angeles. Most providers were "blindsided" by the confusing new forms and regulations.

Of course, the delay would have been more helpful if CMS had announced it earlier, notes Gene Tischer with the trade group Associated Home Health Industries of Florida. "This is the biggest boondoggle CMS has ever been involved in," Tischer charges.

Fork In The Road

Now many HHAs that were geared up for June 1 implementation of the new ABN have a tough decision to make--whether to go ahead with the new form or stick with the old one.

If you use the new forms that were slated to take effect June 1, you also have to use the new, drastically expanded instructions that go with them, CMS had told the National Association for Home Care & Hospice.

Under the old forms, agencies have to issue an ABN only when the physician doesn't agree with the change. Under the new forms, HHAs must issue an ABN whenever services are reduced or terminated.

If you haven't implemented the new forms yet, don't, urges consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT. "It is likely that the regulations will change and further confusion for staff should be avoided at all costs," McNamara says.

But if you already have made the leap to the new forms, it may be worse to turn back now. "If an agency has implemented the new forms, I would stick with them," advises consultant Lynn Yetman with Reingruber & Co. in St. Petersburg, FL. "Changing back would be too confusing for the staff."

Think twice: Still, even agencies that have already begun using the new forms may want to pull them back, McNamara says. The sharp increase in the number of ABNs agencies have to issue under the new forms combined with the likelihood of further instruction changes make it a losing proposition, Tischer adds.

If you do go ahead with the new forms, follow all the new rules as well, McNamara stresses.

Note: Copies of the old and new (1/2006) ABN forms and instructions are at www.cms.hhs.gov/BNI/03_HHABN.asp under the "Downloads" section.