Harmony Healthcare Blog

Denial Letters: ABN = Advance Beneficiary Notice of Non-Coverage

Posted by Kris Mastrangelo on Thu, Mar 01, 2018


Edited by Kris Mastrangelo

C.A.R.E.

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


New SNFABN (Form CMS-10055) for Medicare Part A
ABN (Form CMS-R-131) for Medicare Part B

Writing on clipboard with patient in background in hospital-1.jpeg1) New SNFABN (Form CMS-10055) for Medicare Part A

Effective May 7, 2018, it is mandatory to use the New SNFABN (Form CMS-10055)
In the meantime, it is acceptable to use the old version of the SNFABN, the Denial Letters or the NEMB-SNF, however, Harmony Healthcare International (HHI) recommends immediate implementation of the New SNFABN (Form CMS-10055). 

The New SNFABN (Form CMS-10055) has the requirements from the denial letters and looks very similar to the ABN with 3 different options. 

 Option 1.   I want the care listed above.  I want Medicare to be billed for an official decision on payment, which will be sent to me on a Medicare Summary Notice (MSN).  I understand that if Medicare doesn’t pay, I’m responsible for paying, but 
I can appeal to Medicare by following the directions on the MSN.

 Option 2.   I want the care listed above, but don’t bill Medicare.   I understand that I may be billed now because I am responsible for payment of the care.
I cannot appeal because Medicare won’t be billed.

Option 3 I don’t want the care listed above. I understand that I’m not responsible for paying, and
I can’t appeal to see if Medicare would pay. 

Skilled Nursing Facilities (SNFs) must issue a liability notice to Original Fee-For-Service (FFS) Medicare beneficiaries before the SNF provides: 

  • An item or service that is usually paid for by Medicare, but may not be paid for in this instance because it is not medically reasonable and necessary or
  • custodial care. 

The New SNFABN replaces the NEMB-SNF.  The NEMB-SNF is a voluntary notice to effectively communicate to the beneficiary about care that is never covered by Medicare.  It is important to continue this notice. 

Download the Advance Beneficiary Notice of Non-Coverage Forms

2) ABN (Form CMS-R-131) for Medicare Part B

Facilities must use the Advance Beneficiary Notice of Non-coverage (ABN) (Form CMS-R-131) for Medicare Part B items and services. 

If Medicare doesn’t pay for D.______below, you may have to pay.
Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D._______below.

Option 1.   I want the D.______listed above.  You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but
I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.

Option 2.   I want the D._______listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment.
I cannot appeal if Medicare is not billed.

Option 3.   I don’t want the D.______listed above.  I understand with this choice I am not responsible for payment, and
I cannot appeal to see if Medicare would pay.  

Source: www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html
Chapter 30, Section 70 of the Medicare Claims Processing Manual revisions will be forthcoming.

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: Denials

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