Regulations:
KNOW WHEN TO ISSUE ABNs--AND WHEN NOT TO
Published on Mon Mar 20, 2006
P4P, managed care also addressed in Open Door Forum.
The exceptions for issuing advance beneficiary notices may be getting narrower, dropping even more work in home health agencies' laps.
In the February Open Door Forum for home health providers, a Centers for Medicare & Medicaid Services official implied that HHAs wouldn't have to issue an ABN if they included a reduction in services on interim orders and effected the change a short time later (see Eli's HCW, Vol. XV, No. 9).
But now the CMS official says an agency must issue an ABN if the service reduction wasn't on the original plan of care, according to the April 12 forum. "There should be absolutely no surprises for the beneficiary," she told the forum's 345 listeners.
That means telling patients at admission about service reductions and including those reductions on the 485. If that's not the case, issue an ABN.
The basics: Under the new ABN rules, HHAs must issue ABNs to patients when initiating non-covered care, when reducing non-covered or covered care, and when terminating non-covered care (see Eli's HCW, Vol. XV, No. 8).
Watch for: CMS has been fielding numerous questions about the ABNs, the staffer said. The agency hopes to issue a question-and-answer set clarifying ABN rules very soon. Other issues addressed in the forum include: • P4P. HHAs should find out by summer what quality data they must report to CMS starting in 2007. As a forerunner of a pay-for-performance system, Congress is requiring agencies to report as-yet-unspecified quality data starting Jan. 1 or face a 2 percent reduction in Medicare payments (see Eli's HCW, Vol. XV, No. 13).
CMS aims to issue the proposed rule on "pay for reporting," as an official called the rule, by the end of June, she revealed in the forum. The data appears likely to be drawn entirely from currently collected OASIS data, the staffer hinted. • Managed care. You may see a reduction in the number of patients whose switch to a Medicare managed care plan fails to show up in the Common Working File for months on end. CMS identified system problems with the beneficiary records for managed care plans and has corrected the majority of the problems, a staffer explained.
Claims should process appropriately and inquiries should successfully give accurate information most of the time, the official promised. While "a smattering of issues" may persist, CMS will continue its efforts to make sure the managed care information is updated and accurate, she pledged.
