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CMS Updates ABN Chapter of the Medicare Claims Processing Manual

CMS Updates ABN Chapter of the Medicare Claims Processing Manual

Courtesy of the National Association for Home Care & Hospice

The Centers for Medicare & Medicaid Services (CMS) recently revised the Advance Beneficiary Notice of Non-Coverage (ABN) section 50 in chapter 30 of Pub. 100-04, Medicare Claims Processing Manual via Transmittal 10862/Change Request (CR) 12242. The changes are primarily a reorganization of the material, clarifications, and updates. For instance, some of the examples used have been updated, some deleted, and CMS addresses some common issues more directly and clearly.

Home Health: Medicare Claims Processing Manual, Chapter 30, Rev. 4250, 03-08-19:

An ABN is required at initiation only when there is potential for the beneficiary or his/her secondary insurance to incur a charge. The ABN informs the beneficiary of the potential charges and allows him/her to make a decision regarding whether or not s/he wants care that won’t be paid for by Medicare. An ABN signed at initiation of home health care for items and/or services not covered by Medicare is effective for up to a year, as long as the items/services being given remain unchanged from those listed on the notice.

  • Example 1 – Initiation: A beneficiary requires skilled nursing wound care three times weekly; however, she is not confined to the home. She wants the care done at her home by the home health agency.

The ABN must be issued to this beneficiary before providing home care that will not be paid for by Medicare. This allows the beneficiary to make an informed decision on whether or not to receive the non-covered care and accept the financial obligation. Any one-time care that is provided and completed in a single encounter is considered an initiation in terms of triggering events and is subject to ABN issuance requirements if applicable.

Other instructional components that were previously included in only the home health section of the manual but are applicable to additional provider types were moved and are now covered in new sections. This restructuring of the manual should provide more clarity to providers.

Current ABN forms can be found here.

NAHC encourages providers to review the updated manual to ensure they have a clear understanding of the requirements surrounding the ABN as it is applicable to the services they offer and that they are correctly utilizing the ABN.

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