ABN, HHCCN, and NOMNC: When and Which to Give!

1. Noting the Notice: What, When, and Why

This chapter will provide a clear definition of the purpose of CMS Beneficiary Notice Initiative - the foundation for all of these mandated patient notices. We will discuss the history behind these forms, the tie to the COPs, and provide the “why” behind each form, which provides the adult learner with the desired understanding.

2. Advanced Beneficiary Notice (ABN)

The first notice discussed will be the ABN. This form is used when the clinician identifies this patient is a Medicare beneficiary, but she/he does not believe Medicare will pay for the services planned. This notice shifts financial responsibility away from Medicare, and allows notation if another payer may be billed.

3. Home Health Change in Care Notice (HHCCN)

The second CMS mandated notice is the HHCCN. This notice is used when there is a reduction in services that was unforeseen in the original plan of care. This may be a reduction in the number of disciplines, or the frequency of the visits. There are also two situations in which this form would be used for discharge and we will cover both, discharge “for cause” and if a patient did not have a face-to-face visit with the physician.

4. End of Care Notices and Notice of Medicare Non-Coverage (NOMNC)

When patients meet their goals, or the services are no longer covered by Medicare, due to eligibility concerns, such as level of skill, or homebound status, the NOMNC is provided at least two days prior to discharge. This notice provides the patient the right to appeal this discharge to the Quality Improvement Organization (QIO).

5. Applications of the Notices and Tricks of the Trade

This chapter will discuss tips to ensure you will never question again which form to provide, and when! We will “color code” these forms to make it easy to apply to any situation, and discuss more complex cases where more than one form may need to be provided simultaneously.