Harmony Healthcare Blog

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)
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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. 

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Topics: Medicare Week, Denials

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

Posted by Kris Mastrangelo on Thu, Mar 01, 2018

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

1) 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). 

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Topics: Denials

Five Fundamental Steps for A Denial Free Medicare Audit

Posted by Elisa Bovee on Thu, Jul 07, 2016

Probe, ZPIC, RAC auditors as well as other Medicare Medical Review auditors are quite active throughout the country reviewing PPS and Medicare Part B claims at skilled nursing facility sites.  The request for medical records whether paper or electronic can be a daunting task for providers. Precision and timing are of the essence for a successful review.  CMS considers medical review contractors as being responsible for detecting, deterring, and even preventing Medicare fraud and abuse.  In this capacity, the auditor is directly responsible for operating areas such as investigation, case development, administrative solutions, and referral to law enforcement. 

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Topics: Denials, Medical Record Review, Audits,

Medicare Week:  Fact or Fiction

Posted by Kris Mastrangelo on Tue, Jul 05, 2016

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. 

Read More

Topics: Medicare Week, Denials

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