Advance Beneficiary Notices Have Changed

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By Terry Miller, RN, COS-C 
Regulatory Advisor, McKesson

Advance Beneficiary Notices Have ChangedThe Home Health Advance Beneficiary Notice (HHABN) has been replaced by Advance Beneficiary Notice of Noncoverage (ABN), effective December 9.

HHABNs have been required since 2002 to inform beneficiaries of traditional Medicare services about possible noncovered charges. HHABNs issued prior to December 9, 2013, for ongoing, repetitive services will remain in effect for the time period indicated on the notice, up to one calendar year from the date of issuance. Please note that, like the HHABN, the ABN is in effect for up to one year and must be issued annually for ongoing, repetitive services when notice is required.

CR 8404 essentially replaces Option Box 1 on the HHABN with ABN form CMS-R-131. The new form states that home health agencies must provide notice prior to providing an item or service that is usually paid for by Medicare but may not be paid for in this particular case because:

  •  It is not considered medically reasonable and necessary;
  •  The care is custodial;
  •  The individual is not confined to the home; or
  •  The individual does not need intermittent skilled nursing care.

Likewise, CR 8403 replaces Option Box 2 and 3 on the HHABN with ABN form CMS-10280. Form CMS-10280 states that home health agencies must provide notice:

  • Prior to the HHA reducing or discontinuing care listed in the beneficiary’s plan of care (POC) for reasons specific to the HHA on that occasion (Option Box 2).
  • Prior to the HHA reducing or discontinuing Medicare covered care listed in the POC because of a physician-ordered change in the POC or a lack of orders to continue the care (Option Box 3).

Be sure your staff is not only aware of these changes but that they have the necessary forms to stay in compliance.

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