ABN and NOMNC - Question and Answer Series: Part 1
1. Can you clarify ABNs and outpatient services provided by a therapy company at an SNF? Who is responsible for ABN, the facility, or the therapy company?
- The ABN is not required for Medicare Part B outpatients who come to the facility office for therapy.
- The ABN is provided when the therapist believes that Medicare will not pay for the services to afford the patient opportunity to make an informed decision on cost/care.
- The provider (The entry billing Medicare) is ultimately responsible for notice.
2. If a beneficiary has a Medicare Advantage plan and covered under Medicare Part B, is a NOMNC required?
Is the SNF ABN be required under the above condition (such as the requirement for traditional Medicare if the RP wishes to pay pp for Part B services)?
- The NOMNC is required for all Medicare products:
- Medicare Part A,
- Medicare Part B, and
- Medicare Part C, also known as Medicare Advantage or a Medicare Replacement product. The Medicare Advantage patient would be using Part B under that package and the NOMNC is required.
- The SNF ABN is not required for Medicare Advantage plans, only traditional Fee for Service Medicare A/B.
3. Is an ABN or NOMNC required if patient receives a Medicare Part B evaluation only for therapy and no further skilled treatment is necessary after the evaluation and 1 treatment?
- In HHI’s opinion, the evaluation is a one-time order. There are no treatment orders, nor a treatment plan, or treatment provided.
- The NOMNC is used to identify that treatments will end. In this scenario, there are no services ordered, provided, or ending hence NOMNC not required.
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