The New ABN and HINN (Audio Conference)

AUDIO CONFERENCE ON CD OR AUDIO ON-DEMAND

Sponsored by Medicare Compliance for Patient Access Staff

presented on August 27, 2008

CMS issued important information that your patient access staff needs in order to comply with prior notification requirements under the Limitation of Liability (LOL) provisions of the Social Security Act. Under these provisions, a Medicare patient must receive prior written notice in order to be held liable for certain non-covered services, including those that fail to meet Medicare's medical necessity guidelines. Now a new outpatient Advance Beneficiary Notice of Noncoverage (ABN) and revised inpatient Hospital Issued Notices of Noncoverage (HINNs) are required. If provided correctly, your hospital will be able to collect for those non-covered services from Medicare patients in both the inpatient and outpatient setting.

Train staff to know the rules so you don't miss out on revenue

Listen to HCPro for this 90-minute audio conference The New ABN and HINN: Master Medical Necessity and Collect Appropriate Reimbursement. Revenue cycle management consultant William L. Malm, ND, RN, and healthcare attorney and compliance consultant Judith L. Kares, JD, CPC, break down the important details of the new outpatient ABN and the three inpatient HINNs implemented as part of the revised inpatient notification process and explain how they can affect your revenue cycle. They discuss how to direct your access staff to interact with the patient, and how to deliver the relevant information in a compliant manner. The speakers conclude with case studies to show how you can successfully integrate the provisions of these notices into your existing admission and discharge processes.

At the end of this audio conference, your staff will be able to:

• Understand the basics of LOL for inpatient and outpatient services
• Understand the financial impact for failure to meet LOL notification requirements
• Identify staff roles and responsibilities in the delivery of ABNs and HINNs
• Identify appropriate use of ABN and HINN forms
• Use appropriate modifiers to identify ABN-related services
• Report the provision of ABNs and HINNs, or the failure to do so, appropriately on related Medicare claims
• Identify hospital liabilities and penalties for inappropriate ABN and HINN use, or failure to use appropriately
• Understand the relationship of the new inpatient notification requirements regarding rights upon discharge to the inpatient HINNs
• Understand the compliance and financial risks and penalties for failure to comply with LOL provisions

AGENDA

• Terminology
• Limitation on Liability
• Prior notification requirements
• Applicability to outpatient services
• Applicability to inpatient services
• Distinguishable from other financial protection provisions
• Preliminary findings of the Recovery Audit Contractor (RAC) Demonstration Project
• Claims that failed medical necessity
• Outpatient Setting
• Old Advance Beneficiary Notice
• New Advance Beneficiary Notice of Noncoverage
• Operational challenges
• Inpatient Setting
• Original HINNs
• Focus on three current HINNs and their relationship to other inpatient notification requirements, including the Important Message from Medicare
• Operational challenges
• Compliance and Financial Risks and Exposure
• Failure to provide effective notice (ABN and HINNs) when LOL applies
• Use of ABNs and HINNs when LOL does not apply
• Notice of Exclusions from Medicare Benefits (NEMB) under the old ABN rules
• Use of new ABN for statutorily excluded benefits
• Use of Preadmission/Admission HINN for statutorily excluded benefits
• Recovery Audit Contractor implications
• Case Studies
• Specific situations in which LOL does and does not apply
• How to operationalize the provisions of the notices
• Q&A

MEET THE SPEAKERS

William L. Malm, ND, RN,is the practice director for Revenue Cycle Management Consulting and the Revenue Cycle Institute within the consulting division at HCPro, Inc. He has more than 20 years of experience in a combination of clinical and financial healthcare, including as a compliance officer, revenue cycle specialist, and chargemaster specialist.

Judith Kares, JD, is a practicing attorney and compliance consultant with 23 years of experience representing hospitals, third-party payers and other health care clients in the areas of health care contracting and regulatory compliance. Ms. Kares also serves currently as an instructor for HCPro's Medicare Boot Camp® – Hospital Version.

WHO SHOULD LISTEN?

• Patient access managers
• Managers of billing services / patient financial services
• CFOs
• Utilization review
• Discharge planners/coordinators
• Case management
• Compliance officers
• Internal compliance auditors
• Provider relations professionals
• Medical directors
• Medical staff

PROGRAM MATERIALS

Program materials are provided with PDF links.

AUDIO ON-DEMAND

In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, an audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff. .

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