Ever heard of the SNFABN -- use as notice of noncoverage

[Caralyn Davis]

I decided to look at the new manual system to see what it said about notices of noncoverage, and I found a new Skilled Nursing Facility Advance Beneficiary Notice form. Section 70 in Chapter 30, "Financial Liability Protections," of the Medicare Claims Processing Manual (http://www.cms.gov/manuals/104_claims/clm104c30.pdf) explains when/how to use the form. The new SNFABN form itself is available at http://www.cms.hhs.gov/medicare/bni/ and according to that web site it is supposed to be implemented immediately. Am I the only one who missed CMS notifying facilities about this new form?-Caralyn   Introductory description in chapter 30:     70 - Form CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Rev. 1, 10-01-03) A3-3730.1 Following are the standards for use by Skilled Nursing Facilities (SNFs) in implementing the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN, model Form CMS-10055) notice of noncoverage requirements. This section provides instructions, consistent with the skilled nursing facility prospective payment process (SNF PPS), regarding the notice that SNFs must provide to beneficiaries in advance of furnishing what SNFs, utilization review (UR) entities, quality improvement organizations (QIOs), or Medicare contractors believe to be noncovered extended care services or items or of reducing or terminating ongoing covered extended care services or items. The SNFABN replaces the SNF Notices of Non-Coverage previously used for notification purposes. SNFs must also meet the ABN Standards in �40.3 of the MCPM in completing and delivering SNFABNs. 70.1 - Basic Requirements for SNFABNs (Rev. 1, 10-01-03) A SNFABN is a CMS-approved model written notice that the SNF gives to a Medicare beneficiary, or to her or his authorized representative, before extended care services or items are furnished, reduced, or terminated when the SNF, the UR entity, the QIO, or the Medicare contractor believes that Medicare will not pay for, or will not continue to pay for, extended care services that the SNF furnishes and that a physician ordered on the basis of one of the following statutory exclusions: �Not reasonable and necessary ("medical necessity") for the diagnosis or treatment of illness, injury, or to improve the functioning of a malformed body member - �1862(a)(1); or �Custodial care ("not a covered level of care") - �1862(a)(9). Except for the exclusions specified above, there is no other statutory authority on which the limitation on liability (LOL, �1879) provision applies to SNF claims denied.     ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, November 14, 2003 4:21 PM Subject: MEDICARE DOCUMENTATION/DEMAND LETTER I have 2 questions for the group:   What is the required doumentation for Medicare patients? Is it daily or weekly? And the notification  letter for exhausted benefits, does it have to be send as certified mail and does the copy of the letter has to have a demand letter attached to it?  Or is it ok to just send a letter that says if you have questions abt this letter (exhaust benefits)  you can contact the admissions office. Thanks in advance