Harmony Healthcare Blog

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

Posted by Kris Mastrangelo on Tue, Jul 10, 2018


Edited by Kris Mastrangelo

C.A.R.E.

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


Update hand writing with a blue mark on a transparent boardWe 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)

 

SNFs should no longer use the NEMB-SNF (CMS-20014) as these have been
discontinued with the 2018 SNF ABN revision.
 

Notice of Exclusion from Medicare Benefits (NEMB SNF) is a voluntary notice that may be used with extended care item(s) and service(s) that are statutorily excluded from coverage under Medicare or not covered Medicare benefits. 

  • NEMB-SNF notices alert Medicare beneficiaries in advance that Medicare does not cover certain extended care item(s) and/or service(s) because the item or service does not meet the definition of a Medicare benefit or because the item or service has been specifically excluded by law. As a result, these items or services are not subject to appeal under either appeal process noted above.  Harmony Healthcare International (HHI) recommends facilities utilize the NEMB-SNF to enable beneficiaries to make an informed decision regarding whether to receive the non-covered services for which they will be financially liable. 
  • Examples of scenarios for which the NEMB SNF is appropriate: 
    • No 3-day qualifying hospital stay.
    • The resident was not admitted to the skilled nursing facility within 30 days of his/her hospital discharge.
    • SNF Transfer requirements not met.
    • No benefits from Medicare (Patient does not have Medicare Part A).
    • Patient has used the 100-day benefit from Medicare and has “Benefit Exhausted 

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The NEMB-SNF was used as a voluntary notice to inform beneficiaries of potential liability for items and services that are either subject to statutory denials (i.e. never covered by Medicare) or do not meet technical eligibility requirements (i.e. no qualifying 3-day stay). 

Next Blog Post:  Part VII of VII, Q and A with Sally Fecto, Sr. VP Field Operations, Harmony Healthcare International (HHI).

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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Tags: Denial Letters

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