Policy Manual sample

MDT Home Health Care Agency, Inc. MEDICARE’S ADVANCE BENEFICIARY NOTICE Home Health Change of Care Notice (HHCCN) Purpose To comply with Medicare Home Health Advance Beneficiary Notices' directive. Definition 1. Advance Directive Notices (ABN) are notices that home health agency must provide to Medicare beneficiaries in advance of furnishing care that does not meet Medicare criteria. 2. These notices need to be issued when the physician is in disagreement with the home health agency's decision of non-coverage, reduction, or termination of services due to not meeting Medicare's coverage criteria, or 3. When there is a fee change from Medicare to any other free source. 4. Home Health Change of Care Notice (HHCCN), delivery when the doctor’s orders for home care have changed or our agency has decided to stop giving the home care services. Procedure When to Use ABN/HHCCN 1. If the patient has Medicare and care has not been initiated and you believe services ordered by the physician do not meet Medicare coverage criteria. 2. Before reducing or terminating home healthcare the beneficiary is receiving, if the physician's order would continue the care, but you expect Medicare to deny payment for services. Or HHCCN when the doctor’s orders for home care have changed or our agency has decided to stop giving the home care services. 3. When there is fee change from Medicare to any other payor including but not limited to Medicaid, Medicare Managed Care, commercial issuer, HMO, Full Fee, etc. 4. Exception (NO ABN NEEDED): When billing Medicare and the physician concurs with a reduction or termination of services, you must record such concurrence along with any verbal or written orders by the physician, in the clinical record. Procedure for ABN/HHCCN 1. If you expect home health services to be denied by Medicare then inform the beneficiary orally and in writing before case is initiated or continued, that in your opinion, the care will be paid through Medicaid, through other Insurance OR the beneficiary will be liable to make a payment ''Out of pocket''. 2. Must explain why services are no longer medically necessary or why they will not be covered. In the HHCCN explain any Change in services from the doctor or the Agency. 3. Must notify the beneficiary no later than the end of the business day following the day that you made the assessment. 4. Must use the more current CMS Forms. 5. Must explain the form to the patient in language they will understand. If patient is Home Health Agency Policies A-124