Policy Manual sample

MDT Home Health Care Agency, Inc. non-English speaking, you must have someone Interpret the information. The beneficiary or authorized representative must be able to comprehend the notice. Document on ABN/HHCCN is translated in Spanish (other languages we will get help through family, caregiver or translation services). 6. Must hand delivery the ABN or HHCCN. A telephone notice must be followed up immediately with a certified mailed notice or personal visit. 7. Must be signed by the beneficiary or if incapable then by his/her representative who signs for other Medicare issues. 8. Obtain the signed ABN/HHCCN from the beneficiary in person. If this is no possible the by return mail. 9. If the beneficiary or representative refuses to sign the ABN/HHCCN document the refusal, circumstances and persons involved. Our Agency may then decide not to provide services because the beneficiary has not agreed to be fully and personally responsible for payment. 10. Document on the ABN/HHCCN the date received from the beneficiary. 11. Do not pre-select any option on the form. 12. Leave the original copy with the patient. 13. Take the ABN to Utilization Management. UTILIZATION MANAGEMENT 1. Review ABN/HHCCN for completion including that a date received is present. 2. Mark Medicare Demand Bill and send to Patient Accounts/Billing. 3. If copy was not left with patient, return a copy within 30 days to the beneficiary for their records. 4. Send a copy of the ABN/HHCCN to the physician. 5. Put a copy of the ABN/HHCCN into the clinical record. In any order of change of frequency received by the Agency we will inform the patients, in compliance with their rights, the new frequency changed by our Agreement Addendum form or any other applicable form. NOT TAKEN UNDER CARE (NTUC) MEDICARE BENEFICIARIES 1. There are only four reasons why a patient maybe a NTUC without a visit: a. Patient refuses agency services over the telephone. b. Patient notifies agency that another agency is providing home care. Home Health Agency Policies A-125