Medicare Compliance & Reimbursement
It's A Mistake To Hold Onto That ABN
One of the biggest gray areas regarding the new expedited review notices is how they'll coordinate with advance beneficiary notices - but don't expect guidance on that quandary any time soon.
The Centers for Medicare and Medicaid Services does give some clues on the differences between the new notices and the home health advance beneficiary notice in a new 45 Question and Answer set.
"Expedited determination notices are given to alert beneficiaries, prior to discharge, of their right to obtain an independent, immediate review [of] the upcoming end of Medicare covered care from the HHA," CMS explains in Q&A 42.
"The HHABN is given before the delivery of potentially non-covered care, so that the beneficiary can make an informed choice as to whether or not to assume the responsibility for payment," CMS continues. "The HHABN informs beneficiaries that they may be required to pay for care the HHA believes Medicare will not cover. The HHABN will no longer be used to notify beneficiaries of the end of Medicare-covered care ... the HHA should use expedited determination notices for that purpose."
But during the June 20 special Open Door Forum, CMS officials warned home health agencies not to adopt these new ABN guidelines and the recently proposed forms yet. CMS offered contradictory advice in the forum.
On one hand, officials said expedited review notices replace ABNs when a beneficiary's Medicare-covered services end.
On the other hand, they said agencies should not change anything they're currently doing regarding ABNs, pending finalization of the new forms and rules.
"This just isn't ready for implementation," charges Burtonsville, MD-based attorney Elizabeth Hogue. "There are too many unanswered questions."
The relationship between the new expedited review notices and the HHABN is one of the "most problematic" issues regarding the new requirements, Tony Culotta, director of CMS' Medicare Enrollment and Appeals, admitted in the forum. CMS wants to iron out some problems before it finalizes the new ABNs, so it won't make the July 1 start date.
Heads up: HHAs don't have to worry about the aborted Notice of Exclusions from Medicare Benefits. Even though the NEMB is listed on the CMS Web page for beneficiary notices, it is not in effect, CMS officials stressed in the forum.
With the revised ABN coming online soon, the NEMB likely will never see the light of day. It's "a dinosaur," Culotta noted.
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