C.A.R.E.

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

These questions come from our latest webinar on ABN and NOMNC.
Missed it? You can view it on-demand and download the handouts by clicking here.

1. Question: Can you clarify about ABNs and outpatient service provided by a therapy company at an SNF? Not Part B for inpatients, but for outpatients who come to facility office for therapy.  Who is responsible for ABN, the facility or the therapy company?
   

C.A.R.E.

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

These questions come from our latest webinar on ABN and NOMNC.
Missed it? You can view it on-demand and download the handouts by clicking here.

1. Question: Can you clarify about ABNs and outpatient service provided by a therapy company at an SNF? Not Part B for inpatients, but for outpatients who come to facility office for therapy.  Who is responsible for ABN, the facility or the therapy company?
   

C.A.R.E.

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

Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI). 

1. On the ABN form, it has a place to enter information to contact the Medicare contractor. What information is put here and how do I find this information?
   

C.A.R.E.

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

We have focused the majority of the of the attention on the SNF ABN and NOMNC.  The last letter is the Notice of Exclusion from Medicare Benefits (NEMB SNF) (CMS-20014), which is currently eliminated.  

C.A.R.E.

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

A continuation of the SNF ABN discussion leads to higher perspective on the letter process.  One of 3 entities (SNF, UR, or QID/Medicare Contractor) is responsible for administering a written notification: 

1. The SNF that is furnishing non-covered extended care items or services. 

Examples:  

• On or before the day of admission, the SNF furnishes to the beneficiary a SNF ABN notifying the beneficiary that the extended care item(s) or service(s) is non-covered; or  

• During the inpatient stay, the SNF timely furnishes to the beneficiary a SNF ABN notifying the beneficiary that the covered extended care item(s) or service(s) will no longer be covered.

C.A.R.E.

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

As a continuation of our blog series, here are details around the clarification of requirements for administering the Advance Beneficiary Notice of Non-Coverage(SNFABN).

2. ABN Advance Beneficiary Notice of Non-Coverage (SNFABN CMS 10055) or SNF Denial Letters are known as the traditional denial letters, or SNF Advance Beneficiary Notice (SNF ABN). 

C.A.R.E.

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

As a continuation of the last blog post, here are further details around the clarification of requirements for administering the Notice of Medicare Non-Coverage (NOMNC) and the Advance Beneficiary Notice of Non-Coverage (SNFABN) 

1. The Notice of Medicare Non-Coverage (NOMNC) (Generic Notice) (CMS Form 10123)

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

C.A.R.E.

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

Question and Answer

Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI)

1. When do you give the NOMNC and the ABN at the same time?
   
   You give both the NOMC and the SNF ABN when denying Medicare Part A coverage with days available and the patient is staying in the facility.