In the day-to-day flurry of activity that surrounds home health agencies, there are a few forms that are forgotten and fall through the cracks. We are going to discuss a couple of important ones in this article. Each form is customizable and you will see a link to the CMS website to download the official template. Be sure to review the instructions accompanying each form to ensure that your agency is formatting it correctly. For every one of these notices, the patient receives a copy and a copy is retained in the clinical record.

Notice of Medicare Non-Coverage

The Notice of Medicare Non-Coverage (NOMNC) is required whenever a patient’s ordered home health services are coming to an end. This notice is to be delivered to the patient at least two calendar days before services are expected to come to an end. Reviewers will be looking to ensure that the date services will end referenced on page one is at least two days later than the date signed on page two.

Also, remember that the QIO listed at the bottom of page one has to have your current QIO agency listed. QIOs can change so it’s important to remain up-to-date. Check out the CMS’s QualityNet portal for a current list of Beneficiary and Family-Centered Care QIOs. By the way, a recent update to the therapyBOSS clinician app has incorporated the Notice of Medicare Non-Coverage in its extensive library of electronic documentation. Its smart defaults enable therapyBOSS clinicians to complete a perfectly formatted and fully compliant NOMNC within a few seconds.

Detailed Explanation of Non-Coverage

The Detailed Explanation of Non-Coverage (DENC) is only used when a beneficiary requests an expedited determination. The DENC allows for a more detailed explanation of specific reasons for the end of home health services for the patient.

Home Health Change of Care Notice

The Home Health Change of Care Notice (HH CCN) is required when a patient’s home health care services are going to be reduced or discontinued sooner than planned. Again, if all services are going to be discontinued, use the NOMNC above. This notice replaces the traditional Home Health Advance Beneficiary Notice of Noncoverage (HHABN) Option Box 2 and Option Box 3.

Keep in mind that this reduction in services can be initiated by the physician or the agency. It is not enough to simply have a physician order decreasing frequency of services, the patient is required to receive written notification in the form of the HH CCN. You can be sure that as CMS shifts its focus to client involvement and approval of care, surveyors and reviewers will be looking for these forms any time your chart shows a reduction in services.

According to the instructions, this form cannot exceed one page in length and font size should be between 10-16 point depending on the content and easily readable.

Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage (ABN) is required when services that are typically covered by Medicare will not be covered due to patient-specific circumstances. Examples of this are patients who are no longer homebound or services that are no longer judged to be medically necessary. This notice replaces the traditional HHABN Option Box 1.

In this form, the agency fills out items A through F and provides the patient with the ABN. The patient or their representative checks off one of the boxes in section G and signs and dates the bottom.

Agencies may optionally use this form to voluntarily inform patients of services that they have requested that are never covered by Medicare such as long-term care and hearing aids. In this instance, the use of the form is not required.

The Wrap-Up

Make sure that your agency is using these forms when appropriate. They all demonstrate proof of patient notification and involvement in their care planning which will probably be the focus of surveys for the next few years.