Article Detail - JE Part A
Skilled Nursing Facility and ABN Use
Skilled Nursing Facilities (SNFs) must issue the SNF Advanced Beneficiary Notice of Non-coverage SNF (ABN) to Original Medicare Fee-for-Service (FFS) beneficiaries in order to transfer potential financial liability before the SNF provides:
- Care that Medicare usually covers, but may not be paid for in this instance because it is not medically reasonable and necessary, or
- custodial care.
If the notifier is found to have given improper or incomplete written notice, the Medicare contractor will not hold the beneficiary liable in the individual case.
The Noridian Medical Review staff has found several vulnerabilities using the SNF ABN which are detailed below:
- No SNF ABN was given to the beneficiary prior to termination of covered extended care items or services at the time rendered
- SNF ABN given when the beneficiary continues to require daily skilled services with Medicare Part A benefit days available
- SNF ABN missing the beneficiary or their authorized representative signature, or contains an illegible signature without a printed name
- SNF ABN given and signed to a beneficiary that is not cognitively intact or able to make legal decisions without and authorized signer or Power of Attorney signer/co-signer.
- SNF ABN missing date to reflect when the SNF gave notice in-person, or via phone contact
- SNF ABN missing the required elements making it invalid
- SNF name
- SNF address
- SNF phone number - at a minimum
- TTY number - should be included when necessary to meet a beneficiary’s need
- Option boxes - no selection entered
- CMS Beneficiary Notices Initiatives (BNI) FFS SNF - ABN SNF ABN Instructions (DOCX) under Downloads section
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 70
Last Updated Wed, 30 Dec 2020 21:46:43 +0000