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Regional Home Health & Hospice Intermediary - Palmetto GBA 

Source: www.palmettogba.com

Updated: 01/05/11

Provider Types Affected
All providers submitting claims to Medicare contractors (Carriers, Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), Part A/B Medicare Administrative Contractors (A/B MACs) and Durable Medical Equipment (DME) MACs) for services provided to Medicare beneficiaries are affected.

Provider Action Needed
This article is based on Change Request (CR) 6988. This CR advises contractors about the addition of Section 3.15, ABN and Complex Medical Record Review, to Chapter 3 of the Medicare Program Integrity Manual (PIM). This addition directs contractors to request, as part of the Additional Documentation Requests (ADRs), required ABNs when performing a complex medical record review on all claims. Please ensure that your staffs are aware of this change.

Background
Requesting required ABNs on all claims undergoing complex medical record reviews and conducting face validity assessments of mandatory ABNs will assist in ensuring that liability is assigned appropriately in accordance with the Limitation on Liability Provisions of section 1879 of the Social Security Act.

The instructions in the Medicare Claims Processing Manual Chapter 30 Section 50.6.3 address how to complete an ABN. In CR 6563, Healthcare Common Procedure Coding System (HCPCS) level 2 modifiers have been updated in order to distinguish between voluntary and required uses of liability notices. The MLN Matters® article related to CR 6563 may be viewed at http://www.cms.gov/MLNMattersArticles/downloads/MM6563.pdf.

Additional Information
The official instruction, CR 6988, issued to your Medicare carrier and/or MAC
regarding this change may be viewed at http://www.cms.gov/Transmittals/downloads/R361PI.pdf.

If you have questions, please contact the Palmetto GBA Provider Contact Center at their toll-free number:

  • » Part A: (877) 567-9249

  • » Part B (Ohio & West Virginia): (866) 332-7025

  • » Part B (South Carolina): (888) 828-2092

  • » Railroad Medicare: (888) 355-9165

  • » Regional Home Health and Hospice: (866) 801-5301

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