NewsLine - November 2011 - (Page 34)

Tip of the Month Updated ABN Form Required by Hospice Providers Mandatory Use Begins January 1, 2012 The Centers for Medicare and Medicaid Services recently updated the Advance Beneficiary Notice (ABN) form for hospice providers. The only change to this form is the expiration date—all other information remains the same. The latest version of the ABN form is now available for immediate use and can be accessed from the CMS website (look for the 3/2011 release date in the bottom left corner). Mandatory use of this version begins on January 1, 2012; all ABNs with the release date of 3/2008 that are issued on or after January 1, 2012 will be considered invalid. Using the New Form Issuance of the ABN form to a hospice patient is required when: 1. The patient is ineligible for hospice because he/she is not “terminally ill” as defined in §1879(g)(2) of the Social Security Act (i.e. the statute that authorizes the Medicare Hospice Benefit); 2. Specific items or services that are billed separately from the hospice payment, such as physician services, are not reasonable and necessary as defined in either §1862(a)(1)(A) or §1862(a)(1)(C) of the Act; or 3. The level of hospice care is determined to be not reasonable or medically necessary as defined in §1862(a)(1)(A) or §1862(a)(1)(C) of the Act, specifically for the management of the terminal illness and/or related conditions. Cigna Government Services has developed an excellent descriptive flow chart that members should find helpful. Hospice Guidel ines for the Adv ance Beneficiary Yes cov Notice of Non erage (ABN) (CM Yes S-R-131) iateness Hospice Appropr ry meet Yes Does the beneficia y ill” inall Medicare’s “term definition? No ices Are hospice serv still going to be provided? No The Hospice ABN is not required. Yes The Hospice ABN is required. Level of Care level of care Is the hospice ne, etc.) (i.e. GIP, routi medically reasonable and age their necessary to man terminal illness? No Other Services vices that are Are the items/ser the hospice from billed separate ician payment (i.e. phys e and nabl services) reaso ssary? medically nece No ice services Are these hosp services) still (i.e. physician ided? going to be prov No The Hospice ABN is not required. Yes The Hospice ABN is required. The Hospice ABN is not required. ice ABN is NOT in which a Hosp Other situations required: ♦ Revocations cutive days* ding five conse Respite care excee to ces still going Are hospice servi level of care? this be provided at Yes No The Hospice ABN is not required. The Hospice ABN is required. Web page at give encouraged to *Providers are in these cases. voluntary notice ♦ ♦ Transfers diagnosis to the terminal ♦ Services unrelated the ABN as a of voluntarily in place also be issued Benefits The ABN can sion of Medicare care. the Notice of Exclu is never covered by Medi that (NEMB) for care ed ABN’ the ‘FFS Revis mation, go to .asp For more infor gov/BNI/02_ABN http://www.cms. ines for the Hospice Guidel Are all Medicare covered hospice service ending? No The Generic ED Notice is not required. Yes 123 and ) Notice (CMS-10 ermination (ED 3) is Notice (CMS-1012 all Expedited Det re The Generic ED No Are the hospice services ending due to a hospice transfer? Yes The Generic ED Notice is not required. No than 2 days befo required no later end. covered services ficiary y you the bene Did the QIO notif termination? has appealed the Yes 4) Notice (CMS-1012 A Detailed ED ry by to the beneficia must be given on the day QIO close of business you. notified CMS-10124) Are the hospice services ending ry due to beneficia revocation? Yes The Generic ED Notice is not required. No No additional . action is necessary es’ Web page at the ‘FFS ED Notic mation, go to EDNotices.asp For more infor gov/BNI/06_FFS http://www.cms. 31-01 L C • H - 0 accurate information, trators, L S A d m i n i s effort has been made to assureprofit is prohibited. al for 2011 • CG reasonable  J u l y legal document. Although every services. Reproduction of this materi a the provider of resource is not ssion lies with Disclaimer: This claims submi for correct responsibility 34 NewsLine http://www.cms.gov/BNI/02_ABN.asp http://www.cms.gov/BNI/02_ABN.asp http://www.nhpco.org/files/public/regulatory/Hospice_ABN_vs_ED.pdf http://www.nhpco.org/files/public/regulatory/Hospice_ABN_vs_ED.pdf

Table of Contents for the Digital Edition of NewsLine - November 2011

Helping Your Patients Leave a Legacy
A Message From Don
We Earned Our Merit Badge in Efficiency (display ad)
Commit to a New Friend a Continent Away
Partnering With 3 Hospitals to Provide PC
The Voice of NCHPP
Findings from the National Social Worker Survey
My.NHPCO—a Great Resource for the Hospice Social Worker
Recruiting Problems? HMR (display ad)
Newly Revised—Physician Guide to Hospice Care (display ad)
Make NDL a Part of Your November Outreach
Hospice PSA Reaches 154,000 Viewers in 21 States
WHV Recognizes Outstanding Hospice Partners
Just Revised—A Much-Needed Tool for Physicians
Member News and Notes
Regulatory Tip of the Month: New ABN Form
Preview Our New Education Catalog

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