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HCFA revises proposed ABN for Labs.

The Health Care Financing Administration is moving ahead with plans to standardize advanced beneficiary notices (ABNs) that laboratories and other Medicare Part B providers give to beneficiaries.

ABNs alert beneficiaries that Medicare might not reimburse for certain services even though physicians have ordered them. HCFA has now devised a standardized form for laboratory tests and a separate one for services provided by physicians and other Part B providers. ABNs ask for patients' consent regarding financial liability when Medicare denies coverage.

There always has been a requirement that beneficiaries receive notice and agree that if a test isn't going to be reimbursed, the beneficiaries will pay for it, but there has never been a standardized HCFA form that provides that information.

The proposed ABN includes the following wording: "Medicare does not pay for all of your healthcare costs. Medicare only pays for covered items and services when Medicare rules are met." The form also advises the beneficiary to ask for a further explanation if it is unclear why Medicare probably will not pay and to check how much the item or service will cost, either out-of-pocket or through other insurance.

The beneficiary is asked to check one of two options, and sign and date the form. The first option says, "Yes, I want to receive these items or services," and the second option says, "No, I have decided not to receive these items or services."

This latest ABN is the result of revisions made by HCFA after lab operators, physicians, and other providers gave the agency their recommendations and reactions to an earlier proposal. The latest ABN is available on the HCFA website at www.hcfa.gov/regs/prdact95.htm. HCFA also issued a notice in the April 20 Federal Register giving the public 30 days to comment on the proposal.

Improvements noted

While not entirely satisfied with the proposed ABN, groups representing lab operators are encouraged by the recent revisions. The form contains definite improvements and represents a "step in the right direction," says Mark Birenbaum, PhD, administrator of the American Association of Bioanalysts (AAB) in St. Louis. It is much simpler and contains fewer words, he adds.

In addition, groups representing lab operators are pleased that the proposed ABN is only one page in length. The earlier version contained two pages and was too cumbersome. "Getting the form to one page was a real victory for labs," says Joanne Glisson, vice president of governmental affairs for the American Clinical Laboratory Association (ACLA) in Washington, DC.

As it now stands, many labs have the ABN printed on their test requisitions. Labs are hoping to keep the amount of paperwork to a minimum. The proposed ABN for labs has a structured space for listing individual tests and the reasons for likely Medicare denial.

Another potential problem is the size of the type on the form. ACLA had believed that the preprinted tests to be printed on the form would not have to be in 12-point type, according to Glisson. HCFA, however, is recommending the larger type. It is assumed the agency is proposing the larger type so senior citizens will have an easier time reading the information. As a result, she says, beneficiaries "are probably not going to get the full range of limited coverage tests printed in the box."

Another problem is timing. "I think our members will need more time to start printing the forms, getting them out to customers, and retrieving the forms out there that are no longer appropriate," Glisson says.

Birenbaum says there is a potential concern for a number of AAB member labs that provide services to nursing home patients. AAB asked HCFA to address the issue of an extended course of treatment for these patients. AAB wanted HCFA to include a sentence or two indicating that the ABN is valid for an extended course of treatment. Under this approach, if the treatment changes, a new ABN would have to be signed.

AAB believes this is necessary, he says, because "a special situation exists with nursing home patients. Many are mentally incompetent as far as reading and comprehending the ABN." Often nursing home patients have a relative or guardian reviewing Medicare coverage.

"We need something that allows lab operators to get an approval from a legal guardian that doesn't have to be given each and every time a lab test is ordered," he explains. Unfortunately, AAB's request was not incorporated in the ABN, Birenbaum says.

In the coming weeks, lab groups will express their reactions to the latest ABN, but it is unclear at this point whether the federal government will make any additional changes in the form. In announcing the revised form, however, Health and Human Services Secretary Tommy G. Thompson did say the following: "We want to hear suggestions and recommendations to help us improve these forms so Medicare beneficiaries know what the paper they are given really means."

Joan Szabo is a Washington, DC, freelance writer specializing in healthcare issues. She has been writing the "Washington Report" column for MLO for the past four years.
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Article Details
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Title Annotation:advanced beneficiary notices; Health Care Financing Administration
Author:Szabo, Joan
Publication:Medical Laboratory Observer
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 1, 2001
Words:843
Previous Article:Multitude of professional organizations offers choices and benefits for laboratorians.
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