New CMS rules on HHABNs expand applications; increase confusion
Don't waste staff time; read instructions carefully and educate clinicians
Do you take the ultra-cautious approach and issue a Home Health Advance Beneficiary Notice (HHABN) in any case in which you are not sure if the new rules apply, or do you take a chance and hope that you've interpreted the instructions correctly?
This is the dilemma posed by the mandate by the Centers for Medicare & Medicaid Services (CMS) that requires home health agencies to issue HHABNs in more situations than required before Sept. 1, 2006.
"In the past, the use of an HHABN was very specific and very limited in scope," points out Rachel Hammon, RN, BSN, director of clinical practice and regulatory affairs for the Texas Association of Home Care in Austin. While previously the use of an HHABN focused on the financial liability of a patient for whom services or equipment might not be covered by Medicare, the new rules expand the application to address issues not related to financial liability, she explains. In addition to issuing an HHBN if the patient will be responsible for costs of care, a home health clinician also must give the patient an HHABN if service is being discontinued because the agency can no longer provide service to that patient, or if the physician has changed the orders and determined that home care is not necessary.
In the initial changes introduced in May, home health agencies were given only two option boxes to check off on the HHABN; but after subsequent review and comments from the home health industry, a third option was added to the form, Hammon says. "I was glad to see that we are given the third option in which we explain to patients that the physician has changed his or her orders and we cannot provide care without a physician's orders."
Although the form has not changed from the one introduced in May with the exception of the additional option box, the instructions have significantly changed from what agencies have been using, says Elizabeth E. Hogue, Esq., a Burtonsville, MD, attorney. The instructions for the HHABN are hard to understand, she admits. "If you are in doubt as to whether or not an HHABN is needed, I suggest that you err on the side of caution and issue one."
While you can't get into trouble for issuing too many, there is a cost factor to the agency, Hammon points out. "Although you should make sure you issue HHABNs when needed, it is also important to save the time your clinicians spend on the forms by making sure you understand the instructions so that you don't issue unnecessary HHABNs," she suggests.
The instructions are fairly general, and the biggest challenge for all home health agencies will be interpreting the instructions and applying them to every scenario, says Hammon. "Every agency is different, depending on its size, patient population, and geographic area," she says. "Also, if durable medical equipment is part of your agency's services, then another set of situations will have to be addressed."
Review CMS information
Although there is a Q&A on the CMS web site to help home health managers figure out what is required, the questions and answers have not been updated since June. "I expect to see updated information as more agencies submit questions now that the HHABN rule is in place," Hammon says.
The best way to know what is required is to review the instructions and the existing Q&As carefully, she suggests. "Identify situations that are most likely to occur in your agency and decide if they require an HHABN."
Every nurse, therapist, case manager, supervisor, and manager needs to be educated, says Hogue. Agencies need to determine who makes the final decision to issue an HHABN and clinicians need to understand what situations might require one so that no one misses a situation for which one is required, she says. "There are exceptions to the HHABN requirement," she points out. "Specifically, if the patient is moving to a different level of care, such as the hospital or a nursing home, there is no need to issue an HHABN," she says.
A good resource for training is your state association, says Hammon. "Most state associations have partnered with vendors to provide seminars on HHABN rules and are also posting information on their web sites," she says. Take advantage of these opportunities and keep reviewing the CMS Q&As to stay up-to-date, she suggests.
It is important to be clear about when an HHABN is needed, says Hogue. "CMS is saying that state surveyors will survey for compliance with the new HHABN rules immediately," she says. "It is unclear, though, how surveyors will be able to judge compliance with the same broad instructions that agencies have," she adds. "The inclusion of HHABN compliance does increase the importance that agencies work to identify the proper application of the rule."
Do you take the ultra-cautious approach and issue a Home Health Advance Beneficiary Notice (HHABN) in any case in which you are not sure if the new rules apply, or do you take a chance and hope that you've interpreted the instructions correctly?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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