----- Original Message -----
Sent: Friday, November 14, 2003 5:25
PM
Subject: Ever heard of the SNFABN -- use
as notice of noncoverage
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 -----
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
