ABN and NOMNC - Q and A Series: Part V

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  1. Question: If a resident has met technical requirements for a qualified stay, but refuses Medicare Part A services what beneficiary notice do you use? 

    Answer: There is no required beneficiary notice when the resident is choosing to decline services. It should be documented that the resident is refusing skilled services. An SNF ABN that is given to inform a resident of their potential financial liability before delivering Part A skilled, physician-ordered services that are not expected to be covered by Medicare could be given as a voluntary notice. HHI recommends creating a voluntary notice that is streamlined for this purpose and easily understood instead. HHI can assist you with this.

    1. Question: The patient decides to elect hospice and is on Medicare Part A. What notice is given?

      Answer: There is no beneficiary notice required when a resident elects hospice. If the resident is electing to choose hospice and the reason for hospice is related to the reason for skilled care, then no beneficiary notice is needed as it is the resident deciding to end the skilled services. If the reason for skilled care is unrelated to the reason for hospice and the patient is continuing both Part A services and hospice, no beneficiary notice would be issued.
    2. Question:  Do I understand correctly that the SNF does NOT need to give the Medicare Part B patient an ABN?

      Answer: Delivery of the ABN (CMS R-131) is only required before rendering Part B services that are not reasonable and necessary or considered custodial care and the patient is requesting them. Reasons that Medicare might deny a service or item under the Part B benefit is not reasonable and necessary includes care that is:

 

  • Not indicated for the diagnosis and/or treatment in the specific case
  • Experimental, investigational, or considered “research only”
  • Exceeding the number of services that Medicare allows in a specific period for the diagnosis

 

Three points are known as triggering events when the billing entity is responsible for ensuring the ABN is issued before delivering Part B services that are likely non-covered care and the patient is requesting these services.

 

  • Initiation of services when it is believed services are will not be covered and the patient requests them
  • Reduction of services if the patient wants more services that are identified as not being medically reasonable and necessary
  • Termination of services when the patient wants more services that are no longer considered medically reasonable and necessary

 

A NOMNC (CMS 10123) is a required beneficiary notice when all Medicare Part B therapy ends in an SNF.

usethisinstead

Harmony Healthcare International (HHI) is available to train your staff on MDS. HHI is happy to present you with our 8-week MDS Bootcamp hosted virtually for 1-hour each Wednesday, July 14, 2021 - September 1, 2021, from 1:00 P.M. EST – 2: 00 P.M. ESTThis weekly MDS Bootcamp will cover Medicare Entitlement, Eligibility and Coverage Criteria, Medicare Process, and more! Click below for more information and to register.

Click Here to View MDS Bootcamp Level 1

 

If you are already enrolled in the MDS Bootcamp Level 1, check out the next Level of our MDS Bootcamp Level 2 below! This will be hosted virtually for 1-hour each Wednesday, July 14, 2021 – September 1, 2021, from 2:00 P.M. EST – 3:00 P.M. EST.

Click Here to View MDS Bootcamp Level 2

 
 

Topics: NOMNC, ABN


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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