ABN and NOMNC - Q and A Series: Part 1

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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?

Answer:

 

  • 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.

ABNNOMNC

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)?

Answer:

  • 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?

Answer:

 

  • 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.

 

The Harmony Healthcare International (HHI) on-site and remote visit process is an intensive, detailed review of the medical record content to identify compliance risk areas, revenue and coding opportunities, systematic refinements with the overarching goal to improve medical record accuracy and minimize compliance concerns.

 

To learn more about our site visit process, click here.

 

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 upcoming Competency/Certification Courses. Click here to see the dates and locations. 

Click Here to View HHI's Education Calendar

 

Harmony Healthcare International (HHI) is hosting our 9th Annual Post-Acute and Long Term Care (PALTC) Interdisciplinary Symposium on Thursday, October 21st, 2021 and Friday, October 22nd, 2021 at the Encore Boston Harbor resort and casino.

Click below to register and for more information!

Click Here to Register for harmony21

harmony21 website
 
 

Topics: NOMNC, ABN


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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