ABN and NOMNC - Q and A Series: Part III

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ABN and NOMNC

Question and Answer Series

Part III

  1. Question: Can you clarify, patient resides in the facility, Therapy orders received, and the patient qualifies for Medicare Part B. Pending DC from therapy, are NOMNC (48 hours) and ABN due?

     

    Answer: The NOMNC is required prior to the termination of all Medicare Part B therapy services in an SNF. It is delivered close to the end of services, either on or before the second to last treatment. The ABN (Form CMS-R-131) is only used to communicate ongoing treatment the patient may request, and Medicare will likely not cover it because it is not medically reasonable. The ABN would be provided timely to give the patient information needed to make the financial decision about whether to continue therapy. If they receive the NOMNC and are in full agreement to end therapy, there are no financial concerns or need for the ABN.

    1. Question: What if the POA for an LTC SNF resident who's nuder Med B NOMNC agrees with the d/c and given 48 hours' notice and documented on the letter that the family agrees verbally but unable to sign immediately and requests to sign it when they come to visit in the future? Is that ok? The date signed will not be before the d/c because they come to visit after that. 

       

      Answer: When delivering any notice telephonically, such as the NOMNC, document in detail:

      Who the notice was provided to, the phone number, date and time of the call, their appeal rights, and the pertinent information to appeal the decision. The NOMNC must be given on or before the second to last treatment prior to the termination of all Medicare Part B therapy services in an SNF. Mail the NOMNC certified, return receipt. Ask the family member to sign and date then bring it back or mail it back. This will establish a valid timeline by having the postal documentation for the delivery and receipt. There have been instances in which a family member later states they were not notified. The postal documentation is critical. When the written notice is signed, the contractor will accept the time of the telephone notice as the time of the delivery. If it is not signed, the contractor will not accept a telephone call to an authorized representative to be sufficient evidence of proper notice for limiting potential liability unless the content of the telephone contact can be verified and is not disputed.

      Mail the NOMNC certified, return receipt. Ask the family member to sign and date then bring it back or mail it back. This will establish a valid timeline by having the postal documentation for the delivery and receipt. There have been instances in which a family member later states they were not notified. The postal documentation is critical. When the written notice is signed, the contractor will accept the time of the telephone notice as the time of the delivery. If it is not signed, the contractor will not accept a telephone call to an authorized representative to be sufficient evidence of proper notice for limiting potential liability unless the content of the telephone contact can be verified and is not disputed.

     

    ABN3
    1. Question: Do we give Med B ABN for every patient coming OFF therapy? 


      Answer: No, only if they have Medicare Part B and want more therapy that is not likely to be covered by Medicare Part B.

       

Join Harmony Healthcare International (HHI) in collaboration with PharmScript, LLC. on Tuesday, May 4th, from 3:00-4:00 pm EDT for an upcoming webinar on PDPM and Medicare Skilled Services. The webinar will be presented by Kris Mastrangelo, President, and CEO of Harmony Healthcare International (HHI). Kris will share the following learning objectives:

 

1. Able to articulate the four pillars of skilled care.

2. Understand how to document the skilled care provided and the rationale for it.

3. Learn key components of PDPM and the Minimum Data Set (MDS) coding to support skilled services.

 

NAB has approved the webinar for 1.0 CEU credit.

Click Here to Register for the Webinar

 

 

Pharmscript, LLC is also a proud sponsor of HHI's upcoming PALTC Interdisciplinary Symposium. 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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