CMS R-131 Comment #3 thru #6

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I N C O R P O

"Bringing the
healthcare
revenue cycle
full circle"

T E D

Comments ABN Revision CMS-R-131
1. It appears the signed ABN must be received in person or via hardcopy mail.
Why is it not acceptable to receive a signed, faxed copy or a signed scanned
copy via email? Patients would benefit from the speed at which ABN's can be
transmitted electronically in a standard format such as .pdf, .tif, etc.

2. Regarding the section entitled "frequent collection": Are we still able to issue one
ABN to cover a period of time for repeated services (such as drug infusions,
chemo, etc)? While we don't currently do this we'd like to have the option to.
3. We believe that an average of 7 minutes per response it too low. We estimate
that we average 10-15 minutes to issue each ABN. Staff time includes patient
discussion, ABN creation either via use of triplicate form or software application,
ABN routing to PFS and HIM and ABN scanning into repository system. This
does not include the time involved should a patient seek further clarification from
a physician or ask to speak with a financial counselor.
4. Do providers still have the option to notate (and sign with two witnesses) that the
patient was informed, refuses to sign form but insists upon service? If so, where
is the appropriate place on the form for the witnesses to sign?
5. We may not be able to gather, at times, middle initial to match Medicare records.
Will this produce a problem upon audit?

6. Does Blank C need to contain the HIC# or can it contain the provider-generated
account number or medical record number for the beneficiary? The previous
form stated HIC on the form. The proposed form just states Identification
Number.

7. The previous form asked for "Patient Name". 'The proposed form asks for
"Beneficiary Name." While providers understand the term beneficiary, will all
patients? This does not seem to follow the CMS goal of putting all verbiage on
the ABN in user-friendly language.

8. Blank H is not a useful field. It may confuse the patient if they enter the name of
a secondary carrier and are stilled billed for the service.
9. A place for the Total Estimated Cost of all services listed is useful to the patient.

740 Kenmar Industrial Parkway
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()3 Medicare Rights Center
BOARD OF DIRECTORS
Robert A

March 15,2007

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Chainnan
Weiler Amow Management Co., Inc.

Marilyn M w n
V ~w
Md
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HmIth
Amrican InstiPlkd ofRuearch

Donna Regenatreif, Ph.D.
Bruce C. Vladeck
Interh h i d e n t
Univ. of Medicine 81 Dentistry of NJ

CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development - C
Attention: Bonnie L. Harkless
Room C4-26-05
7500 Security Blvd.
Baltimore, Maryland 2 1244-1850

William Elernstein

Re: Comments on Revised Advanced Beneficiary Notice

Pmmer
Manatt, Phclg & Phillips,LL?

Dear Ms. Harkless:

Diane Archer
Founder
Medicare Righb Center

Arthur Aufses, M.D.
Prufessor, Deportmenls of Surgery &
Healfh Policy
Mount Sinai Schwl of Medicine

Micki Chen
Vice Resident. Deputy G e n m l
Counsel - Telecom Marketing
Veriwn Comnications, Inc.

The Medicare Rights Center ("MRC") is a nonprofit consumer organization that helps
older people and people with disabilities get access to affordable health care. MRC staff
reviewed the revised Advanced Beneficiary Notice ("ABN) and offer the comments
below:
MRC likes the lines added to the box where providers list the items/services concerned
and reasons they expect them not to be covered. We also think the "estimated cost"
column is positive addition, instead of merely suggesting below the box that beneficiaries
ask about cost. And we like the inclusion of the statement, "This is not an official
Medicare decision."

Daniel A. DeVito
Pmmer
SLadden, A p , Slate, Meagher
81 Aom LLP

Edith Everett
hident
Everett Foundation

Elizabeth Fowler
Vice F'resident. M l i c Policy &
External Afairs
Wellpoint. Inc.

Salomeh Keyhani, M.D.
Asrismnl +or,
Dqarhnenrr of
Healrh Policy & Medicine
Mount Sinai School ofMedicine

Nina Lesavoy
Pame

cus GqJirrl

Alan B. Lubin
Ezscvliw Vice h i d e n l
New York State United Teachers

However, MRC is concerned about the addition of "Option 2." Since Option 2 is the first
option listed that gets beneficiaries the items/services concerned, people may choose it
without reading it thoroughly or reading on to Option 3 - then lose the opportunity to
have Medicare billed and be stuck with the cost of the items/services themselves. Option
2 does not seem to have any potential benefit for consumers, but beneficiaries may
assume that it does - otherwise why would it be included in a form advising them of their
rights -and check it out of confusion. Also, it seems that if "Option 2" is eliminated
from the new form, then the "We must bill Medicare when you ask us to" paragraph,
which is also confusing (again, under what circumstances would a beneficiary not want
Medicare billed?) can be eliminated as well, and the form can just state, "We may help
you with billing other insurance in addition to Medicare."

Stephen M. Merkel
Executiw h q i n g Director
CanlorFitlgerald Inf.

In general, the "Options" box on the old form seems clearer and more consumerprotective than the box on the new form.

Joel L. Olah
Executive Director
Aging Resources of Central Iowa

Thank you very much for your attention.
Robert M. Hayes
hident
Medicare Righb Center

,.'
Washington, D.C. ofti<,...
1 IOMaryland Aw. NE,Suite 112
washiniton, DC 20002
Tel: 202-544-55611Fax: 202-544-5549

-.
Z u e l l l h e Cheney
Deputy General Counsel

d-

520 Eighth Avenue, North Wing, 3rd Floor, New York, N Y 10018 Tel: (212) 869-3850
www.rnedicarerights.org
43%-

Fax: (212) 869-3532

PEWNSTATE

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The Miltorl S. Hershey
M e d i d (Center

Patient Financial Services
PO Box 853, Mail code A410
Hershey, PA 17033
(717) 53 1-5695
(717) 531-4010(fax)

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March 9,2007
CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development - C
Attention: Bonnie L. Harkless
Room C4-26-05,
7500 Security Blvd.
Baltimore, Maryland 21244-1850

RE:

CMS-R-131

Dear Ms. Harkless,
I would like to comment on the revision to combine the two Advanced Beneficiary Notices into
one. My orlly concern is that the forms are already very wordy and combining the two forms
will just add more words to the page which is hard for the patients to understand. Also, I
would prefer to see the form remain one page.
I am very interested in this form being easier for the patients to read and understand. If by
making this revision you are doing that, then I am in support of your decision.

Thank you for considering my comments on the matter.

1

Sincerely,

b bas ti'

A

Mary
Team Manager. Medicare Facility Exceptions

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I N T E G R I S
XeczkX.
CORPORATE COMPLIANCE
3030 Northwest Expressway, Suite 501
Oklahoma City, OK 73 1 12-5466
Phone (405) 949-6081
FAX (405) 95 1-4895

March 7,2007

CMS. Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development - C
Attention: Bonnie L. Harkless
Room C4-26-05,
7500 Security Blvd.
Baltimore, Maryland 2 1244-1850

RE: Proposed Change to ABN Form CMS-R-131
OMB Approval No. 0938-0566
We are responding with comments on the proposed change to the ABN form. We
support the initiative to move to one standard form rather than the three previous ones.
We have some concern with underlining the language in the Box (G) Options. It may
cause beneficiaries to not read all three options thoroughly before simply selecting the
l
decision, rather than either of the other two options advising
choice, I can a p ~ e athat
them they cannot appeal. This will cause providers to file more claims to Medicare for
determinations and result in an increased workload for the Intermediaries and Carriers.
Also we noted a typographical error at the bottom with "Privay" Notice. Should this be
"Privacy"? If so, the language is not standard language used in a privacy notice. This
may cause confusion.

Sincerely,

,
FACHE, CHC
Nancy J. ~ & d m MPH,
Vice ~resideM
Corporate Compliance & Privacy Officer
INTEGRIS Health

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