Remain in compliance with the Centers for Medicare & Medicaid Services (CMS) regulations and minimize exposure to retrospective denials by properly delivering HINNs and ABNs to Medicare patients.
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The last thing any patient wants after undergoing a medical emergency— especially during the coronavirus pandemic—is a large bill from their hospital for services they assumed were covered by their insurance. But, in order to bill patients for those services that may not be covered for inpatient or outpatient services, team members must issue the appropriate notices, either the ABN or HINN. If documents are not delivered within the proper time period, it could affect the hospital’s reimbursement, affect the patients understanding of their rights, and increase the risk for payer audits and loss of revenue.
The bottom line: CMS requires facilities that care for Medicare and Medicaid patients to handle an array of documents to ensure that the patient understands their rights. These specifically include knowledge of patients’ possible financial responsibility, admission status while hospitalized, and the ability to appeal when they do not feel they are being discharged appropriately. These notification documents can be a cumbersome process in the best scenario for hospitals to manage but with the addition of COVID-19 during the past year, a new element of difficulty has been added. To help mitigate this problem, RACmonitor offers a timely and important webcast that discusses the definitions and uses of the HINN and ABN with inpatient and outpatient admissions.
Accurate and proper delivery with an understanding of these letters will increase patient satisfaction, compliance with CMS regulations, and a decrease of the exposure to retrospective denials. Case management experts Stefani Daniels and Marie Stinebuck offer solutions to common struggles that case managers and utilization specialists face when trying to identify the appropriate notice and how they can successfully have this conversation with their patients during COVID-19 and beyond.
Why This Is Relevant:
COVID-19 has decreased the interactions with the patient and the family members. For the elderly Medicare patients, phone calls to discuss these topics and the lack of family at the bedside have increased the need to be diligent with follow-up of these conversations and the delivery of the HINN and ABN. Also, patients in precautionary isolation have less staff time allowed in their rooms thus making essential in-person discussions of these topics difficult.
Who Should Attend:
Case managers; utilization review specialists; laboratory, imaging, and revenue cycle personnel; admitting and registration; acute hospital central business office personnel; CFOs
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