Home Health & Hospice

Confusion over HHABN and ED Clarified

Homecare Insider, November 15, 2010

A recent Homecare Insider article, published on October 18, stirred up some confusion regarding the Home Health Advance Beneficiary Notice (HHABN) and Expedited Determination (ED) Notice. The discussion pertained to discharge of patients from homecare without the continuation of non-covered care. Let’s take a look at this issue again and clear up any confusion.

Agencies must issue HHABNs if, during the episode, reductions in care that Medicare usually covers occur. There are two exceptions, which include:

  • There are no charges to the beneficiary
  • A recognized exception applies

Beneficiaries must receive notice for ANY terminations of homecare. Homecare agencies are required to provide an ED Notice to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give beneficiaries the opportunity to request an expedited determination from a quality improvement organization.  For the purposes of the Conditions of Participation, either an ED Notice or an HHABN can fulfill this requirement, except when non-covered care for which the beneficiary may be liable will continue after termination of coverage (i.e. not homebound, etc.) or terminations not related to coverage policy (i.e. agency closure, etc.). In that case, both notices would be required.

Guidelines for the HHABN, including notice requirements and format can be found in Transmittal 1025 of the Centers for Medicare and Medicaid Services (CMS) Manual System (Pub 100-04 Medicare Claims Processing). Guidelines for expedited determinations are in Transmittal 594, CR 3903 dated June 24, 2005. The beneficiary notices and instructions are available on the CMS website at www.cms.hhs.gov/BNI.

Beacon Health’s Guide to Medicare Service Delivery is an excellent resource.  It, and all of our products, may be purchased at www.beaconhealth.org.