Harmony Healthcare Blog

Notice of Medicare Non-Coverage (NOMNC) Advance Beneficiary Notice of Non-Coverage (SNFABN) Part VII

Posted by Sally Fecto on Thu, Jul 12, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI). 

  1. On the ABN form, it has a place to enter information to contact the Medicare contractor. What information is put here and how do I find this information?
Read More

Topics: Denial Letters

Notice of Medicare Non-Coverage (NOMNC) Advance Beneficiary Notice of Non-Coverage (SNFABN) Part VI

Posted by Kris Mastrangelo on Tue, Jul 10, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


We have focused the majority of the of the attention on the SNF ABN and NOMNC.  The last letter is the Notice of Exclusion from Medicare Benefits (NEMB SNF) (CMS-20014), which is currently eliminated.  

3.  Notice of Exclusion from Medicare Benefits (NEMB SNF) (CMS-20014) Read More

Topics: Denial Letters

Notice of Medicare Non-Coverage (NOMNC) Advance Beneficiary Notice of Non-Coverage (SNFABN) Part V

Posted by Kris Mastrangelo on Tue, Jul 03, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


A continuation of the SNF ABN discussion leads to higher perspective on the letter process.  One of 3 entities (SNF, UR, or QID/Medicare Contractor) is responsible for administering a written notification: 

  1. The SNF that is furnishing non-covered extended care items or services

Examples:  

  • On or before the day of admission, the SNF furnishes to the beneficiary a SNF ABN notifying the beneficiary that the extended care item(s) or service(s) is non-covered; or  
  • During the inpatient stay, the SNF timely furnishes to the beneficiary a SNF ABN notifying the beneficiary that the covered extended care item(s) or service(s) will no longer be covered.
Read More

Topics: Denial Letters

Advance Beneficiary Notice of Non-Coverage (SNFABN): Part IV

Posted by Kris Mastrangelo on Thu, Jun 28, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


As a continuation of our blog series, here are details around the clarification of requirements for administering the Advance Beneficiary Notice of Non-Coverage(SNFABN).

  1. ABN Advance Beneficiary Notice of Non-Coverage (SNFABN CMS 10055) or SNF Denial Letters are known as the traditional denial letters, or SNF Advance Beneficiary Notice (SNF ABN). 
Read More

Topics: Denial Letters

Notice of Medicare Non-Coverage (NOMNC): Part III

Posted by Kris Mastrangelo on Tue, Jun 26, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


As a continuation of the last blog post, here are further details around the clarification of requirements for administering the Notice of Medicare Non-Coverage (NOMNC) and the Advance Beneficiary Notice of Non-Coverage (SNFABN) 

  1. The Notice of Medicare Non-Coverage (NOMNC) (Generic Notice) (CMS Form 10123)

Give any time the facility believes Medicare will no longer pay for skilled services. 

Read More

Topics: Denial Letters

Question and Answer: NOMNC and SNFABN: Part II

Posted by Sally Fecto on Thu, Jun 21, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Question and Answer

Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI)

  1. When do you give the NOMNC and the ABN at the same time?

    You give both the NOMC and the SNF ABN when denying Medicare Part A coverage with days available and the patient is staying in the facility. 
Read More

Topics: Denial Letters

Notice of Medicare Non-Coverage (NOMNC) and Advance Beneficiary Notice of Non-Coverage (SNFABN) - Part I

Posted by Kris Mastrangelo on Tue, Jun 19, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


This past month’s HarmonyHelp hotline fielded an inordinate amount of questions on the SNF Denial Letters.  The following blog post is intended to help clarify the confusion since the changes implemented May 7, 2018. April 30, 2018. 

  1. Notice of Medicare Non-Coverage (NOMNC) (Generic Notice and Detailed Notice) (CMS Form 10123) 
  1. ABN Advance Beneficiary Notice of Non-Coverage (SNFABN CMS 10055)  (This form is new.  The ABN was used with 5 denial notices of NEMB form)
Read More

Topics: Denials

Medicare Week:  Fact or Fiction

Posted by Kris Mastrangelo on Thu, Jun 14, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


What are the hot topics from last week on the audit front?  Medicare and Medicare Advantage claims are being denied for a misunderstanding of the “Medicare Week”. Denials occur when the service delivery exceeds the Physician Ordered frequency of treatment. 

What is the Medicare week?  Is it Sunday to the following Saturday?  Depicted by facility specific policy? Or some misconstrued term that evolved over the years like camp fire ghost stories. 

Read More

Topics: Denials, Medicare Week

MDS PPS Assessments Compliance (Part 2): Missed Assessments

Posted by Kris Mastrangelo on Thu, Jun 07, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


As a continuation of Tuesday’s blog post, lets discuss missed assessments. The fundamental difference between a missed and late assessment is where the patient is at the time of the due assessment.  A late assessment occurs when the patient is still in the facility while a missed assessment occurs when the patient is no longer in the facility or denied Part A Benefits. 

Read More

Topics: MDS Assessments

MDS PPS Assessments Compliance (Part I): Late Assessments

Posted by Kris Mastrangelo on Tue, Jun 05, 2018

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Harmony Healthcare International (HHI) performs monthly auditing, monitoring and educational services to the healthcare industry. During our on-site monthly audits, we hone in on MDS Assessments.  Compliance of MDS content accuracy and timeliness are critical focus areas as they impact care planning and reimbursement. 

The MDS contains over 1,000 data elements.  Precision requires constant focus and implementation of systems with inherent checks and balances.  

The most frequently asked questions on HarmonyHelp relate to the parameters for timely MDS Completion. 

Read More

Topics: MDS Assessments

Subscribe to The HHI Blog

Posts by Topic

see all
harmony18
ICD-10 - Is Your Staff Ready? Download Our ICD-10 On-Demand Webinars Today

Stay connected!

Instagram