Doctor is caring a sick patient.

There is one significant change worth noting.

Despite the ongoing COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has continued to update regulations and manuals in order to ensure that the correct regulatory information is available to all. Two weeks ago, they released 26 pages of changes to the manual instructions for the use of the Advance Beneficiary Notice of Non-Coverage (ABN). This update comes after CMS made its usual every-three-years updates to the ABN form and completion instructions.  

Fortunately, many of the changes can be viewed as cosmetic adjustments to wording, with little consequence. For instance, in the revision, they add the word “healthcare” before every instance of “provider.” This seems to be done to separate healthcare providers from suppliers.

As most know, there are situations in which an ABN is not required – for instance, for cosmetic surgery or custodial care. In the new manual instructions, they changed the word “voluntary” to “optional” to describe these situations. Now ABNs are either mandatory or optional, and no longer mandatory or voluntary.

In describing this optional use of ABNs, they added the phrase “CMS strongly encourages healthcare providers and suppliers to issue the ABN for care that is never covered.” What regulatory weight does “strongly encourage” carry? That’s a legal question, but an administrative law judge (ALJ) may not look as kindly on a healthcare provider that did not issue an optional ABN when CMS strongly encouraged them to do so if a patient filed an appeal and claimed they were not aware they would be held financially liable for a service.

There is one significant change worth noting, which will require adjustment to the actual use of the ABN. If you are presenting an ABN to a patient with Medicare and Medicaid, you can only charge the patient after submitting the claim to both payors and getting twin denials. As a result, on the ABN you must cross off the corresponding sections in option 1 for these patients. If you have a dually eligible patient, be sure to read the updated manual or form instructions.

They also reformatted the sections on ambulance, hospice, rehab, and home care. Most notably, they removed the case examples that were in the previous version. They also removed any reference to the use of abbreviations that was present in the home health section of the previous manual.

Most providers find case examples very helpful, and it is not clear why these were removed. Their example of unclear abbreviations was very straightforward, whereby they explained that “PT” used by home health providers could be physical therapy, prothrombin time, or part time. Abbreviations on forms should always be avoided; expecting a patient to know a medial abbreviation and understand how it applies to a situation is fraught with risk.

And finally, everyone welcomes the removal of obsolete sections of manuals, and here CMS removed the four pages that pertained to the use of the ABN when a patient hit the therapy cap – since the therapy cap no longer exists.

The official CMS manual page still does not have the revisions posted, so those interested in reading the revised section can find Change Request 12242 online here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r10862cp.

Programming Note:

Listen to Dr. Ronald Hirsch when he makes his Monday Rounds, Monday on Monitor Mondays, 10 Eastern, and sponsored by R1RCM.

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