Medicare Compliance & Reimbursement

Telemonitoring exception is one plus for agencies.

The clock is ticking toward the Sept. 1 effective date for Medicare's new home health advance beneficiary notices (HHABNs), and federal officials are scrambling to defuse a time bomb of confusion that persists regarding new requirements.

"Agencies have their hands full," as they wrestle for clarification on the questions that remain, says Judy Adams of LarsonAllen in Chapel Hill, NC.

The Centers for Medicare & Medicaid Services (CMS) published the final HHABN instructions in the CMS manual system on Aug. 11. The new instructions completely replace the existing HHABN instructions in section 60 of Chapter 30 of the Medicare Claims Process Manual, explained CMS' Elizabeth Carmody, speaking at the most recent Home Health, Hospice and DME Open Door Forum.

Go to the source: You will find the instructions in CMS Transmittal R1025CP (Change Request 5009). To download the 56-page document, go to www.cms.hhs.gov/Transmittals/2006Trans/list.asp.

At the Aug. 15 Open Door Forum, CMS made these clarifications:

• Do use the new fee-for-service HHABN exclusively--with one exception. Home health agencies (HHAs) still need to issue a generic expedited determination notice at termination if both of the following apply:

1. Care is ending because of Medicare coverage policy and

2. No noncovered care will continue after Medicare coverage ends.

Additional clarification: Expedited determinations are required only at the end of a planned course of covered treatment (usually delivered over the course of time). One example: When an HHA is administering a therapy plan of care. HHABNs are not used for one-time or sporadic item or service, explains CMS.

• Don't issue an HHABN for a service that your agency always provides gratis.

Rule: You don't have to issue an HHABN if your agency never charges for the service--and that includes the initiation of telemonitoring services. The word on that troubling issue comes from Carmody, who answered a related question during the recent Open Door Forum.

Be certain: Remember, you are freed from issuing an ABN only if you never charge for the service in question.

Keep Liability Limitation In Mind

• Do provide an HHABN for one-time items or services if the beneficiary might be liable. HHAs don't have to issue an HHABN or an expedited determination notice when providing one-time noncovered treatments if there is no beneficiary liability. But CMS' final instructions clarify that agencies should issue a notice using the Option Box 1 to inform beneficiaries that they might be liable for the cost of the item or service.

Exception: If the one-time service is provided under a Medicare benefit other than home health (for example, when an agency acts as a DME supplier under Part B), no notice is required. Keep in mind that Medicare views any one-time item or service as an "initiation" not a "termination," said Carmody during the forum.

• Don't issue an HHABN for services that are never covered by Medicare.

Notices are not required for initiating, reducing or terminating services that are never covered by Medicare, confirms Rick Ingber, president of VantaHealth Consulting in Philadelphia.

Example: HHAs that provide a "meals-on-wheels" service or routine foot care for patients would not be required to issue notices when triggering events occur, notes the National Association for Home Care.

Note: CMS posted the new HHABN as the top bullet in the list of downloads on its Web site at www.cms.hhs.gov/BNI/. For instructions and forms in both English and Spanish, click on the link to the left for "FFS HHABN."