Medicare Compliance & Reimbursement

Providers will use new option the most, CMS says.

The new home health advance beneficiary notice (ABN) may cut down on confusion in one vital area, but there's still plenty to go around.
 
After postponing the new ABN's June 1 deadline, the Centers for Medicare & Medicaid Services (CMS) now has issued revised forms and instructions and set the new deadline for Sept. 1.
 
The main change is the addition of a third option box related to physicians' orders.
 
Then: Previously, CMS offered two option boxes on the form ...quot; Option Box 1 for Medicare coverage issues and Option Box 2 for situations where the agency reduces or terminates services for its own reasons such as staffing, patient compliance or safety, etc.
 
Now: Option Box 1 still addresses coverage issues and Option Box 2 still covers an agency's own reasons for reducing or terminating care. But Option Box 3 specifically addresses situations where the physician's orders call for a change to the care plan.
 
Agencies and patients don't have to fill in any information when agencies use Option Box 3. It simply states: "By signing below, I understand that I received this notice because my doctor has changed my orders and so my home health plan of care is changing. This Home Health Agency has explained to me that they cannot provide home care without a doctor's order."
 
HHAs must use Option Box 3 "when the HHA stops providing certain items and/or services due to lack of a physician order, but other care continues," CMS notes in its new instructions accompanying the revised forms. If no care continues, agencies would issue an expedited determination notice.
 
Most popular: Use of the Option Box 3 language "will greatly simplify the notice process in these situations," CMS says in its instructions. "This language should be used the most often of all option box language and will significantly reduce the time involved in notification in these situations," the agency maintains.

One More Form To Worry About

Pro: The new third option box "should help with clarity," predicts consultant Judy Adams with LarsonAllen in Charlotte, NC. Previously, agencies had to use Option Box 1 even when a doctor ordered changes in care, and that option tells patients they can seek the same care from other agencies without explaining that agencies can't furnish such care without a physician's order.
 
Con: But the new option also "adds one more form for HHA staff to carry around," Adams notes. Providers' paperwork burden will increase significantly under the new ABN.
 
Providers that were expecting to see more sweeping changes to the notices after CMS' dramatic eleventh-hour delay of the June 1 deadline will be disappointed, says attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. Besides adding the third option box, CMS has made few changes to the forms and instructions, and those are minor.
 
One change is that CMS has significantly revised its burden estimate for the notices, the National Association for Home Care & Hospice points out. The agency now expects 10.3 million ABNs per year at a cost of $75 million -- a significant increase.
 
Formerly, CMS said agencies would take six minutes to complete the forms, Adams points out. Now it says 18 minutes to complete Option Box 1, and four minutes each to complete either the Option 2 or Option 3 boxes.
 
The cost: CMS' annual cost estimate per HHA is $9,877, Adams notes. And CMS estimates agencies will complete two Option Box 3 notices per episode, as the most frequently used option.
 
While a more realistic burden estimate is gratifying, it will have little direct impact on providers, points out Burtonsville, MD-based health care attorney Elizabeth Hogue.
 
Note: The new forms, instructions, supporting statement and PRA submission statement are at www.cms.hhs.gov/PaperworkReductionActof1995/PRAL/list.asp (6/23 listing for CMS-R-296).