HME NewsPoll: Providers using ABNs but with great caution

Thursday, January 21, 2010

YARMOUTH, Maine – Faced with capped equipment rentals and more extensive Medicare rules for various equipment categories, providers have increasingly turned to advance beneficiary notices (ABNs) to protect themselves.

In a recent HME NewsPoll, 92% of providers said they currently use ABNs; and 82% expect to increase their use of the forms in the coming year.

"With all of the cuts from Medicare, we just can no longer absorb some of the costs that we used to be able to," wrote Bill Armstrong, of American Oxygen Kompany in Centennial, Colo. "This comes as a shock to the patients, but when we explain that they are capped and what that means, they are more understanding."

Other providers aren't sure ABNs are useful.

"We don't use ABNs a lot," wrote one provider. "With the hard times our country is facing, most of our patients do not want the equipment if it is not covered by Medicare."

That soft economy, however, is driving another provider's use of ABNswhen his competitors go out of business.

"Many patients are left without a supplier to service their equipment," wrote Kevin Hoskinds, with Absolute Medical in Arkansas. "I cannot supply parts and labor for a product if I don't know what the original supplier had for documentation."

In a nutshell, the ABN is a form signed by the patient before certain services are rendered, notifying him/her that Medicare may not cover the service and that the patient will be responsible for payment.

But there are a lot of gray areas, providers say. Although 92% of poll respondents use ABNs, only 83% say they are confident that they understand how to use them.

"You never understand how and when to appropriately use them 100% of the time," wrote Dawn Jorgensen, of Mid Columbia Health Equipment, in The Dalles, Ore. "I am confident that we use them correctly, but I believe that even with those of us who understand (how to use them) there is (a chance) of misunderstanding."

Certain Medicare guidelines, like the patient compliance requirements for CPAP that went into effect in November 2008, have led them to increase their use of ABNs.

"I expect to increase the use of ABNs due to the (CPAP) changes," wrote one. "I still feel it's unclear how and when to use these when dealing with Medicare CPAP patients, but I have been led to believe that we can't use these until the patient demonstrates they are not compliant."

Some providers simply throw up their hands when it comes to the ABN.

"I usually take the loss on my markup rather then try to use the ABN," wrote one provider. "I have taken several classes on the ABN, but it's terribly complicated."