Patient Rights:
Get To Know Your ABN Options Before The Deadline Hits
Published on Tue Apr 19, 2005
CMS offers up some differences between ABNs and termination notices. Buckle up for a bumpy ride down the road to ABN compliance.
The Centers for Medicare & Medicaid Services issued the new advance beneficiary notice and its instructions in conjunction with a May 6 Federal Register notice (see Eli's HCW, Vol. XIV, No. 18, p. 140). With the new notice, home health agencies have a choice of including two different statements on the ABN. The First Option Under the first statement, agencies must estimate the cost of the services and items and say whether they think insurance will cover that cost. Then patients choose from these three options:
"1. I don't want the items and/or services listed above. I understand that I won't be billed for the items and/or services and that I have no appeal rights since I will not receive any items and/or services.
2. I want the items and/or services listed above, and I agree to pay for the items and/or services myself. I don't want a claim submitted to Medicare or any other insurance I have. I understand that I have no appeal rights since a claim won't be submitted to Medicare.
3. I want the items and/or services listed above and I want a claim submitted to (Please check one or both of the following): _ Medicare _ my other insurance."
The form then explains that if the patient selects option 3, she will receive a Medicare Summary Notice (MSN) detailing Medicare's official decision regarding whether Medicare will pay her claim. The MSN also will contain instructions on how to appeal that decision.
Good news: HHAs can charge upfront for the services in dispute. "You may have to pay the full cost at the time you get the items and/or services," the form warns. "If Medicare or your other insurance decides to pay for all or part of the items and/or services that you have already paid for, you should get a refund for the appropriate amount."
HHAs likely will issue the newly released termination notices for patients who want to appeal termination of services, notes consultant Regina McNamara with LW Consulting Home Health/Hospice Division in Harrisburg, PA. Then patients can pursue an expedited appeal and the agency's time of furnishing disputed services will be shorter. That's good because when "the care is not covered, the reality is that agencies will simply add to their uncollectible accounts," McNamara predicts. The Second Option Under the second statement, HHAs will issue this language to patients instead of the three options: "By signing below, I understand that the Home Health Agency's decision to no longer provide the items and/or services listed above doesn't change my Medicare coverage or other health insurance coverage. I also understand [...]
