CMS-R-131 Comments #41 and #42

Allina Hospitals & Clinics
Regulatory Affairs
PO Box 43 hlail Route 10 105
hfinneapolis, hfN 55440-0043

ALLINA. .
Hospitals & CIinics

CMS, Office of Strategic Operations and Regulatory Affairs
Division of Regulations Development-C
Attention: Bonnie Harkless
Room C4-26-05
7500 Security Boulevard
Baltimore MD 21244-1850
RE: Draft Revisions to the Advanced Beneficiary Notice

Dear Ms. Harkless;
On behalf of Allina Hospitals and C h c s , I appreciate the opportunity to comment on the
proposed changes to the Advanced Beneficiary Notice (ABN). A h a Hospitals & Clrnics is a
family of hospitals, clinics and care services that believes the most valuable asset people can
have is their good health. We provide a continuum of care, from disease prevention programs,
to technically advanced inpatient and outpatient care, to medical transportation, pharmacy,
durable medical equipment, home care and hospice services. A h a serves communities
around Minnesota and in western Wisconsin. A h a hospitals submit well over 300,000 claims
annually, representing $2.0 bilhon in total charges. Needless to say, we have a vital interest in
providmg our patients with the most up to date and accurate information regardmg their
potential financial liablhty.
We appreciate the efforts of CMS to simplify the form for both providers and beneficiaries;
however we do have concerns with how these proposed changes wdl impact us in the lab
setting, where the need for ABN's is very frequent due to the Lab NCD. In the past, we have
modified the Lab ABN to include a listing of all of 20+ tests that most often hit a potential
non-coverage situation with a check box used to indtcate whlch specific tests are to be
performed. In reference lab, most of our clients do not know what specific tests they need to
get an ABN on. We use the listing of the 20 + lab tests and they just check the appropriate
boxes. Please clarify in the guidance what the parameters are in modifying the form to
support efficiency and clear direction to beneficiaries. We hope that we wdl still have the
option to modify the ABN for this purpose in the lab.
We are concerned with the new requirement to estimate cost for all items/services listed on
the ABN. Currently this is by choice/desire of the patient and we would support the
continuation of this practice. To take the time to identify the estimated costs for every lab test
ordered that may not be covered is very significant when the majority of our patients have no
interest in the cost and only want the service provided.

In section G we are very concerned about Option #2 and the potential need for split billing if
the patient receives both non-covered and covered lab tests in the same visit. The patient may
decide they want to be bded directly for the non-covered services and have Medicare billed
for the covered services. We would need to produce two bills for the same visit and our
systems may not be capable of doing h s . We strongly advocate dropping the second option
and staying with the 2 options presented on the current ABN form.
In section H on the signature, we ask that you clarify what occurs if the patient refuses to sign
the ABN. Please give written guidance supporting the current approach where two staff initial
the ABN in front of the beneficiary who stdl demands the service be provided. Addtionally,
we want to be sure that if the ABN is not complete that we can continue to bdl Medicare with
a GZ modfier and have the claim become provider liable.
Thank you for the opportunity to provide input on the proposed revision to the IM form.
Please feel free to contact me at 612-262-4912 if you have any further questions.
Sincerely,

L"d@"'

Nancy G. Payne, RN
~ i r e c t o Regulatory
r
Affairs

Street Address: 292.5 Chicago A r3etzue,Minneapolis, Minnesota 55407
An E ( / I K I 0l)portrtnity
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(A) Supplier/Provider:
(B) Beneficiary Name:

(C) Identification Number:

Advance Beneficiary Notice of Noncoverage (ABN)
BOTE: If Medicare does not pay for things listed below, you may have to pay.
wcVihink Medicare will not pay for the "Item(s)/Service(s)" listed below because of certain rules for coverage
described under "Reason". You still can receive this care, since you or your health care provider may have good
reason to think you need it, but it is likely you or other insurance will have to pay. We have estimated about how
much you may have to pay under "Estimated Cost" to help you decide whether or not to receive the care listed.

(D) Item(s)/Service(s):

(E) Reason:

(F)
- h

~ e d f c a r wants
e
us to be sure you make an informed choice. Read this whole notice, which explains our
o inion that Medicare won't pay. This is not an official Medicare decision. Ask us for more explanation
i vou need it. For auestions on this notice or on Medicare billing. vou can also call 1-800-MEDICARE

f

You need to make a choice about receiving the care listed above. You must choose only one of the three
options below. We cannot choose for you.
We must bill Medicare when you ask us to. We may help you with billing other insurance if you choose
Option 2 or 3 below, though Medicare cannot require us to do this.
(G) OPTIONS

0 1.

Do not provide me with anything listed above. With no care provided, there is no billing.
I understand that I cannot appeal to Medicare when choosing this option.

P 2.

Provide me with what is listed above. I do not want Medicare billed. I agree to be responsible
for payment. I understand that I cannot appeal to Medicare when choosing this option.

3.

Provide me with what is listed above. I want you to bill Medicare for an official decision on
payment. You can ask for payment now that will be refunded if Medicare pays. I understand
that if Medicare does not pay, I can appeal that decision.

(H) Other insurance to consider for billing:
Your signature below means that you have received this notice and understand it. You will also get a copy.
(J)Date:

(I) Signature:

PRIVAY NOTICE: According to the ~ a ~ e r w o r i ~ e d u c tAct
i o nof 1995, no persons are required to respond to a collection o f information unless i t displays

a valid O M B

conrrol number. The valid O M B control number for this information collection is 0938-0566. The time required to complete this information collection is estimated to
averugc (0 huurs)(7 minutes) per response, including the time to review instructions, search existing data resources, gather the data needed. and complete and review the
information cEllection. I f you have commcnls concerning the accuracy o f the time estimate or suggestions for improving this form, please write to: CMS, 750() Security
BOUIU~'::;~.
Attn: PRA Reports Clearance Officer, M a i l Stop C4-26-05, Baltimore. Maryland 21244-1850.

OMB Approval No. 0938-0566

Form No. CMS-R-131

(June 2007)