CMS Clarifies ABN Instructions for Dually Eligible
February 19, 2014 04:01 PM
The Centers for Medicare & Medicaid Services (CMS) has issued change request (CR) 8597 which provides corrections and clarifications to the Advanced Beneficiary Notice (ABN) instructions in the Claims Processing Manual.
The CR clarifies instruction for home healthcare providers when completing the ABN for dually eligible beneficiaries. The option boxes on the ABN form CMS-R-131, that replaced the HHABN form CMS-R-296, do not provide a clear explanation for dually eligible beneficiaries when Medicaid will be the primary payer for services because they do not meet Medicare coverage criteria. The language on the form is structured so that beneficiaries could mistakenly believe they will be financially liable for services when Medicare will not pay, regardless of the availability of other payer sources.
CMS will permit agencies “to direct the beneficiary to select a particular option box to facilitate coverage of other payers” which is an exception to the ABN general instructions. The CR also provides instructions on which option boxes should be completed and additional information that can be provided when the state either does or does not require a claim be sent to Medicare for denial prior to billing Medicaid.
To view the CR, please click here.