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September 15, 2006

Hospice Advance Beneficiary Notice (ABN)

On June 30, 2006, the Centers for Medicare and Medicaid (CMS) issued an update to the provider manual addressing the use of ABN in the hospice setting. The deadline to implement the change is September 29, 2006.

The update makes it clear that in the hospice setting, the ABN is still issued as a liability protection tool. The update also adds a situation in which an ABN should be issued. A hospice provider should issue an ABN if specific items or services billed separately from the hospice benefit were not reasonable and necessary. The update provides some example language to use on your hospice ABN
forms as well.

This update also includes a discussion on beneficiaries who receive inpatient care that has not been arranged by the provider. In other words, if your patient wishes to continue as an inpatient after you determine it is no longer necessary, you must provide the patient an ABN to inform them they are responsible for the charges. You may arrange to have the facility provide the notice. If the patient revokes the hospice benefit while in the facility, the facility becomes responsible to provide the liability notice.  

The revision also outlines when an ABN is not necessary. A hospice does not need to issue an ABN if the patient revokes the hospice benefit, if respite care exceeds the five day statutory limit (although CMS encourages you to issue a notice of exclusion from Medicare benefit), if the patient transfers to another hospice or when providing care to a patient who has not elected the hospice benefit.

Finally, the revisions reiterate if you are terminating hospice care for reasons related to Medicare Coverage, you should issue an expedited determination notice. If you continue to provide non-covered care, you should issue the expedited determination notice and an ABN. 

For the latest ABN form from Briggs, click here.





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