Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims

The purpose of the ABN is to appropriately notify a Medicare beneficiary of services that the HHA believes Medicare will not cover. In order for the services to be deemed as a beneficiary liability, the ABN must be completed correctly and all information from the ABN must be reflected on the final episode claim. Any services rendered and not noted on the ABN will be deemed the provider’s financial responsibility.

There are a few important tips that will help ensure your agency is appropriately completing and delivering the ABN:

• It must be issued to the beneficiary and signed and dated by the beneficiary (or their legal representative) prior to rendering any of the noncovered services indicated on the ABN.
• It must contain specific information regarding the noncovered services and indicate all services the HHA believes Medicare will not cover. For repetitive or continuous noncovered care, the HHA must specify the frequency and/or duration of the item or service. Some examples of how the services can be listed include:
  • Home health aide visits 1-5 times per week and as needed for one year
  • Nursing visits as needed for one year
  • PT visits twice a week for four weeks
  • OT visits weekly for eight weeks
  • Wound care supplies monthly for three months
• Do not use abbreviations unless the abbreviation is explained on the form. It is acceptable to include a range for the frequency or to include “as needed.”
• If there is a change in the noncovered services provided, then a new ABN must be issued. 
  • Example: The existing ABN says home health aide services will be provided three times a week. The aide services are increased to daily. A new ABN is required to inform the beneficiary of the increase in services. 
  • Example: The ABN says nursing services will be provided weekly for four weeks and then a decision is made to have the nursing visits provided for an additional month. This would require the HHA to issue a new ABN to the beneficiary.
• There must be a cost estimate for each item/service listed on the form.
• All portions/sections of the ABN must be completed in order for it to be considered a valid form.
• The beneficiary (or their legal representative) must choose one option under Blank G.

Note: If your medical records and the information on your final episode demand claim do not match the noncovered services indicated on the ABN, any services billed on the claim beyond what is indicated on the ABN will be deemed provider liability. The beneficiary is only financially liable for the services listed and detailed on the ABN.