The ABN: It's time to declare victory!

Thursday, February 28, 2002

There is a plaque on my office wall that reads "Nothing will ever be attempted if all possible objections must first be overcome." I am not sure who the wise person was who first spoke these words but they have guided me through many difficult challenges, not the least of which, is the current effort to gain acceptance of the Advance Beneficiary Notice (ABN) procedure as a means of providing consumers with HME that meets their lifestyle, as well as medical needs.

Almost every day I hear from another provider who is afraid to take advantage of this opportunity because their heads are filled with misinformation, erroneous interpretations and obfuscations.

Some providers are scared off by statements made by DMERC staff, who have failed to read, much less understand, the Program Memorandum issued by CMS on October 22, 2001. Key officials from at least one DMERC have publicly stated, "...We are not ready for this. There are several systems deficiencies and numerous process issues to be addressed before we can process claims utilizing the ABN process." The Program Memorandum was unequivocal in the fact that its effective date was January 1, 2002 and thus the DMERCs have no choice but to fairly and accurately process all claims involving the ABN submitted after that date. Moreover, every single DMERC was represented in the audience at Medtrade when CMS Administrator Tom Scully said, without hesitation, "this provision is effective now and the people who are supposed to be implementing it should remember that they work for me." The DMERC had plenty of notice to resolve problems and revise policies and procedures. Any DMERC that is unable or unwilling to process claims using the ABN process is failing to live up to the terms of their contract with the government.

Our industry must not cower at the irresponsible utterances of a few DMERC staffers, many of whom remind me of a little boy who always has ten reasons why he does not have his homework completed. We owe it to ourselves, and our customers to use this process now and force the DMERC to work through any internal problems they may have - real or perceived! If we do not submit claims using the ABN process, they have no reason to address the problems. We fought for ten years to get treated the same as other providers when it comes to dealing with their patients/customers. We must not subordinate these gains to contract bureaucrats who have every incentive to delay and suppress use of the ABN.

Other providers are listening to a small group of lawyers, consultants and billing service staff who advise them that there are "too many unanswered questions on the ABN." Let's be real! When was the last time that there was any change in any Medicare policy that was absolutely clear and without questions on its effective date?

CMS acknowledged up front that there would be some issues arising from the use of the ABN (establishing maintenance and service base, etc.) and that they would address them as they came along. Let's take them at their word and get on with the business of serving beneficiaries. When questions come up, we can present them to CMS and push for quick and responsive resolution.

After decades of being treated differently than other healthcare providers, HME providers are finally able to offer their customers choices - just like everyone else paid under Medicare Part B. We can't afford to be pushed around by contractors who see the ABN as extra work and we should not listen to a few self-proclaimed experts whose real agenda may just be to create more work and billable hours for themselves. In short, let's act like the professionals we are and serve our customers professionally and ethically. That includes not shying away from the opportunity to look at the entire spectrum of a consumer's needs for HME and using every tool at our disposal to see that these needs are met.

Throughout the 10-year battle to secure the right to offer beneficiaries the opportunity to upgrade, there were people at HCFA (now CMS) who called the idea "unnecessary" and suggested that HME providers were too unsophisticated to use such authority. They must be reading some of the dribble coming from various sources and saying to each other 'see, I told you so.'

Caution is in order. Avoidance is unnecessary. It is prudent to make sure that your business has all the policies and procedures in place to effectively and ethically use the ABN process. However, it is folly to avoid using this tool to serve your clients because uninformed or ill-intentioned individuals are telling you that the sky is falling.

- David T. Williams is director of government relations at Invacare Corp. HME