Harmony Healthcare International (HHI) Blog

Notice of Medicare Non-Coverage (NOMNC) and Advance Beneficiary Notice of Non-Coverage (SNFABN) - Part I

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Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Hand with marker writing the word MedicareThis 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)Historically, SNF providers were instructed to issue the SNFABN Form CMS-10055 or one of the 5 SNF Denial Letters for items and services paid under Medicare Part A and the SNFABN Form CMS R-131 for items or services paid under Medicare Part B to inform Original Medicare Beneficiaries of their potential liability in accordance with the limitation on liability provisions set forth in Section 1879 of the Social Security Act (the Act).  

    SNFs should no longer use the 5 SNF Notices of Non-Coverage (Denial Letters) as these are discontinued with the 2018 SNF ABN Revision. 
    (This form is new.  The ABN was used with 5 denial notices of NEMB form)(This form is new.  The ABN was used with 5 denial notices of NEMB form)
    • Medicare Part A SNFABN (Form CMS-10055) 
    • Medicare Part B SNFABN (Form CMS-R-131) 

      SNFABN (Form CMS R-131) was required for items or services paid under Part B

      • (this is the ABN and not the SNF ABN)
      The ABN, Form CMS-R-131 should be used for Part B non-covered items or services (this is the ABN and not the SNF ABN)
harmonyhelp
  1. Notice of Exclusion from Medicare Benefits (NEMB SNF) (CMS-20014)

    SNFs should no longer use the NEMB-SNF (CMS-20014) as this is discontinued with the 2018 SNF ABN revision. The NEMB-SNF was used as a voluntary notice to inform beneficiaries of potential liability for items and services that are either subject to statutory denials (i.e. never covered by Medicare) or do not meet technical eligibility requirements (i.e. no qualifying 3-day stay).

    The Revised SNFABN replaces the formerly used:
    • SNF ABN
    • 5 SNF Denial Letters
    • NEMB (Form CMS-20014) 

The below table provides an at a glance of who, what, when and why on the necessary letters. 

NONMC
“Generic Notice”

ABN

NEMB
No Longer in Use

Notice of Medicare Non-Coverage

ABN Advance Beneficiary Notice of Non-Coverage

Notice of Exclusion from Medicare Benefits

(CMS Form 10123)

(Form CMS-10055)
Part A
(Form CMS-R-131)
Part B

(CMS-20014)

Give any time the facility believes Medicare will no longer pay for skilled services

Provide the beneficiary with the opportunity in writing to request that the SNF submit a demand bill to the fiscal intermediary or Medicare Administrative Contractor (MAC) before receiving physician-ordered services that are non-covered due to a lack of medical necessity or because the services are custodial care

subject to statutory denials (i.e. never covered by Medicare) or do not meet technical eligibility requirements (i.e. no qualifying 3-day stay

Delivered no later than two days before the date of the end of coverage

Only given in situations where the resident remains in the facility receiving non-covered care at the conclusion of Medicare Part A coverage.

 

 

Completed by the provider and signed by the beneficiary

Completed by the SNF, the UR entity, the QIO, or the Medicare Contractor

 

 

Next blog post will be a Question and Answer on the most Frequently Asked Questions on NOMNC and ABN with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI).

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


harmony20 October 29-30 2020 Encore Boston Harbor

Topics: Denials


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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