CMS has modified the Medicare Claims Processing Manual to require home health agencies (HHAs) to begin using the standard advance notice of noncoverage (ABN) used by other providers, rather than the previous HHA ABN (Form CMS-R-296).  HHAs are required to issue ABNs to HHA patients when the HHA expects that CMS will (i) not cover an item or service set to be provided to the beneficiary at the initiation of his/her course of treatment; (ii) reduce or stop coverage of an item or service a beneficiary currently is receiving; or (iii) end coverage for all services being provided to the beneficiary during the course of treatment. The ABN may only be issued if the HHA expects that CMS will not cover the service at issue, and not simply when the HHA believes that CMS will deny payment because of a billing defect.  The ABN must contain a good-faith estimate of expected costs to the beneficiary for the services at issue, and the beneficiary can choose whether to receive or forgo the services.  The beneficiary may also opt to receive the services nonetheless and instruct the HHA to seek payment from CMS anyway.  If CMS denies the claim, the HHA may collect payment for the denied services from the beneficiary; however, if CMS pays the claim, the HHA must refund any amounts previously collected from the beneficiary for the paid services.   

The ABN and additional instructions to HHAs on ABN use are available here.

Reporter, Christopher Kenny, Washington, DC, + 1 202 626 9253, ckenny@kslaw.com.