Home Health Advance Beneficiary Notice
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8404 which discontinues the use of the Home Health Advance Beneficiary Notice (HHABN), effective December 9, 2013. Home health agencies (HHAs) may now use the Advance Beneficiary Notice (ABN) in place of the HHABN, Option Box 1. CR 8404 also implements guidelines for issuing the ABN when outpatient therapy services (Type of Bill 34X) are not medically reasonable and necessary.
CMS also issued CR 8403
, which introduces the Home Health Change of Care Notice (HHCCN) to replace the HHABN Option Box 2 and the HHABN Option Box 3 for change of care notifications. Mandatory use of the ABN and HHCCN is effective for items and services provided on or after December 9, 2013. Refer to the Advance Beneficiary Notice (ABN) and the Home Health Change of Care Notice (HHCCN) CGS Web pages for additional information.
The Home Health Advance Beneficiary Notice (HHABN) is designed to protect the beneficiary and the home health agency. It informs the beneficiary of the potential of noncoverage by Medicare, and allows them to make an informed decision about whether to continue care. An HHABN must be given to a Medicare beneficiary in cases where care is physician-ordered and Medicare denial is expected for one of the following statutory bases:
- Services not medically necessary and reasonable (under §1862(a)(1) of the Act);
- Services are to provide custodial care (under §1862(a)(9) of the Act); and
- Failure to meet the homebound and intermittent care requirements (under §1879(g)(1) of the Act).
For more details regarding the HHABN, refer to CMS's Beneficiary
Notices Initiative (BNI)
Web page or the Medicare Claims Processing
Manual (Pub.
100-04, Ch. 30, § 60)
.
Additional Resources
- Medicaid
Coverage of Medicare Beneficiaries (Dual Eligibles) At a Glance
fact
sheet - Home
Health Demand Denials (Condition Code 20)
Web page - Home
Health No-Payment Billing (Condition Code 21)
Web page - Demand
Billing Information Sheet for Home Health Providers
quick resource
tool
Updated: 10.17.13

