As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Home Care Corporate Compliance Manual includes this customizable template, Use of Advance Beneficiary Notice. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Use of Advance Beneficiary Notice:

	POLICY: This organization informs the patient/family in writing of any charges for the patient will be liable prior to furnishing the item or service. The patient/family has the option of signing the form. If the patient signs the form: The appropriate modifier is included on the claim form; The signed, written notice is maintained in the patient's medical record; Is available when requested by the DMERC. Each advance notice shall be individualized for the patient and for the item or service at issue. Generic notices are not utilized. PROCEDURE: The patient/family is informed of...
Second excerpt:
	...patient/family refuse to sign the form at time of delivery, the organization representative is to contact the Clinical Supervisor/Operations Manager or On-Call Supervisor immediately. The supervisor will notify the CEO or his/her designee and the treating physician who will collaboratively decide whether or not the equipment is to be delivered or the service is to be provided, based on the medical necessity and documented clinical status of the patient. Documentation of the...