June 28, 2017

Beware: New Important Message from Medicare Now Required

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If you listened to last week’s edition of the RACmonitor-produced Internet broadcast Monitor Mondays, you heard a reminder from Nancy Beckley that the Centers for Medicare & Medicaid Services (CMS) has released a new version of the Advance Beneficiary Notice (ABN), and that using the old version will automatically render it invalid.

You may also recall that I first announced the news about this new version back in April when it was first released, and that I suggested you start cleaning out your file cabinets. At that time, the new ABN had gone through all the steps, including posting on the Paperwork Reduction Act page, and had been approved by the Office of Management and Budget (OMB). I also noted that the sample ABNs CMS posted on the ABN website use abbreviations, yet the use of abbreviations in the past has led to contractors ruling an ABN invalid.

Because I did not want to be hypercritical of CMS at that time and thought one critique was enough, I did not mention that past ABNs had indicated an approval date on the bottom of the form. Out of the blue, CMS changed it to an expiration date on this new version. Of course, they have the right to change their own form, but now the ABN violates its own instructions in the Medicare Claims Processing Manual, Chapter 30, section 50.6.1, which notes that “ABNs are effective as of the OMB approval date given at the bottom of each notice.”

So why did I decide that now was the right time to be hypercritical of CMS, besides the fact that my loyal readers expect it of me? Well, CMS just posted new versions of the Important Message from Medicare (IMM) and the Detailed Notice of Discharge (DND) on the Hospital Discharge Appeal Notices web page. And if Juliet Ugarte Hopkins, MD, a member of the RACmonitor editorial board, had not noticed this, we would all still be in the dark.

What does “being in the dark” mean in this situation? It means that hospitals that did not use the updated forms would be violating a key federal regulatory notice requirement and could be at risk of losing their accreditation.

While ABNs are used in acute-care hospitals only occasionally, every single Medicare-eligible patient admitted as inpatient gets a copy of the Important Message from Medicare. And how important does CMS think this is? Well, they did put the word “important” in the name of the form.

Speaking of importance, did you know that CMS estimates that each year almost 24 million initial notices are issued and over 3.4 million hours are spent distributing them? If hospitals dedicate that much time to one piece of paper, it better be important!

But in light of all this, why did CMS not send out one single email about the new form, not add it to the weekly MLN Connects edition, or do any outreach at all? It is beyond explanation (although CMS should provide one, along with an apology).

I should point out that aside from the change from a date of approval to a date of expiration, the new form only differs from the old form by the addition of two lines at the bottom concerning non-discrimination as it pertains to the Rehabilitation Act of 1973.

Perhaps they waited 44 years to add this language so they could say a five-year wait to get an appeal heard at the administrative law judge (ALJ) level is not such a long time, relatively speaking.

So don’t delay: go to https://www.cms.gov/Medicare/Medicare-General-Information/BNI and in the left-hand column you will see a link for the FFS ABN page. Click there to get the updated ABN and a link to the Hospital Discharge Appeal Notices for the updated IMM and DND.

And be sure that the new forms are used hospital-wide; if a surveyor shows up and asks to see your current form, it will not be pretty should the old ones still be in use.

Ronald Hirsch, MD, FACP, CHCQM

Ronald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays.

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