NewsLine - October 2012 - (Page 44)
Tip of the Month When to Use the ABN
NHPCO Regulatory Assistance receives many questions from providers about the proper use of the ABN—the Advance Beneficiary Notice for hospice patients. CMS recently updated the Medicare Claims Processing Manual (Chapter 30/Financial Liability Protections) to reflect new guidance concerning both the ABN and the Notice of Medicare Noncoverage (NOMNC). Per this new guidance, the ABN should only be issued when: • The patient is determined to be no longer “terminally ill” by the hospice physician. • Specific items or services that are billed separately from the hospice payment, such as physician services, are not reasonable and necessary. • The level of hospice care is determined to be not reasonable or medically necessary, specifically for the management of the terminal illness and/or related conditions (i.e., the patient no longer qualifies for a GIP stay and refuses to leave the inpatient unit). When it is determined that the patient is no longer terminally ill and the patient is discharged from hospice, the hospice must issue the NOMNC (CMS 10123). If the patient wants to continue receiving hospice care that will not be covered by Medicare, the hospice would issue an ABN to the beneficiary in order to transfer liability for the non-covered care to the beneficiary. If no further hospice services are provided after discharge, ABN issuance would not be required. NHPCO developed the following chart to assist providers in deciding which notice should be issued to their patient at the time of discharge.
Discharge Reason Patient moves out of service area or enters a non-contracted facility Patient is no longer terminally ill
ABN or NONMC Issuance No CMS form is issued Two-day notice, with issuance of NONMC if no further services are to be provided Two-day notice, with issuance of ABN and NONMC if services are expected to continue
Discharge for cause Patient revokes the hospice benefit
No CMS form is issued Patient signs revocation form; No CMS form is issued
Visit the NHPCO Regulatory & Compliance Center for more information about the ABN and NONMC, with convenient links to the CMS forms.
44
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Table of Contents for the Digital Edition of NewsLine - October 2012
How to Lose a Million Dollars
A Message From Don
11 Strategies to Sustain a PC Program
2012 VLVC: An Example of Things to Come
The New Outreach Ads are Here!
The Voice of NCHPP
Teaching Tips to Improve Retention
Free RAE Section Activities
2012 Circle of Life Honorees
How the Fiscal Cliff Will Affect Hospice
World Day 2013: Plan Ahead
Simione: Solving Your Hospice Challenges (display ad)
Member News and Notes
When Life Gets Serious: Glatfelter (display ad)
NHPCO’s Affinity Program (display ad)
Compliance Tip
CTC 2012 (display ad)
Videos Worth Watching
News From NHF
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