The home health agency should give you a written notice, called a "Home Health Advance Beneficiary Notice" (HHABN), if it:
- Makes a business decision to reduce or stop giving you some home health services or supplies while continuing to give you other home health services.
- Reduces or stops giving you some home health services or supplies because your doctor changed your orders.
- Plans to give you a home health service or supply that Medicare probably won’t pay for. The notice should describe the service or supply, and explain why Medicare probably won’t pay.
The HHABN will explain what service or supply is going to be reduced or stopped, and instructions on what you can do if you want to keep getting the service or supply.
The HHABN gives clear directions for getting an official decision from Medicare about payment for home health services and supplies and for filing an appeal if Medicare won’t pay.
In general, to get an official decision on payment, you should:
- Keep getting the home health services or supplies if you think you need them. The home health agency must tell you how much they will cost. Talk to your doctor and family about this decision.
- Understand you may have to pay the home health agency for these services and/or supplies.
- Ask the home health agency to send your claim to Medicare so that Medicare will make a decision about payment. You have the right to have the agency bill Medicare for your care.
If Original Medicare pays for your care, you’ll get back all of your payments, except for coinsurance or deductibles, including any coinsurance payments you made for durable medical equipment.