Don't forget the copy to the physician Theresa Lang Specialized Medical Services, Inc
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Joanne Stutesman Sent: Thursday, December 04, 2003 10:28 AM To: [EMAIL PROTECTED] Subject: RE: Denial Notices - Maria? I'm curious if anyone has yet made the change to the new SNFABN form # CMS-10055? I don't recall the process with the new manuals being online, should we actually expect a separate notice of changes to the manual? At least sections 20, 30, 40 and 70 that I have reviewed all carry a revision date of 10-1-03, would this be the date they were moved to the new online version? In section 70.1 I am reading that a SNFABN is to be issued is "when the SNF, UR, QIO or Medicare contractor believes that Medicare will not pay for, or 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 1) Not reasonable and necessary..., 2) Custodial Care." Section 70.2.2.2 indicates that "...if Medicare is expected to deny payment for an item or service which is a Medicare benefit because it does not meet a technical benefit requirement... A SNFABN should not be given". 70.2.2.2 would indicate to me that a SNFABN would not be necessary if the resident did not have a qualifying stay, nor at the time they exhausted their benefits (I think there may have been more within section 70 to indicate this). Would others agree? Also, the "Proper Denial Paragraphs" (70.4.5) do not include technical denial examples. I did see a lot of good details within this that either are new or I just wasn't aware of previously such as mailing the original and a copy to the beneficiary with the original returned to the facility and then a copy of the completed form returned to the beneficiary (rational is given for this process. Feedback and other interpretations welcome! Joanne -----Original Message----- From: Infante, Marie [mailto:[EMAIL PROTECTED] Sent: Wednesday, December 03, 2003 10:10 AM To: [EMAIL PROTECTED] Subject: RE: Denial Notices The term "sarasett notices" comes from the history of these denial notices and demand letters. They are the result of a lawsuit filed many years ago (I believe in California) that resulted in a settlement between the advocates and (at the time)HCFA....As part of the settlement, HCFA agreed to develop a procedure to inform Medicare beneficiaries about coverage determinations (coverage not eligibility) at the time of admission and provide a procedure for the beneficiary to challange the determination of non-coverage by requesting that a "demand bill" be filed with the FI so that the FI would make a determination of coverage or noncoverage rather than the SNF. These notices predate the ABNs used in other settings and for Part B benefits and in light of recent developments, it appears that CMS is attempting to induce some consistency into the system for all providers and for all items and services. CMS semms to have gotten ahead of itself again on implementation instructions and they should issue some clarification so providers know what to do. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Winona M. Phelps Sent: Tuesday, December 02, 2003 6:14 PM To: '[EMAIL PROTECTED]' Subject: RE: Denial Notices Hello. Here is the link to the Medicare Northwest web site: http://medicare.regence.com/medicare_part_a/whats_new/index.html Below is an excerpt from their site under "Billing non-covered charges": (the first option on the list). Scroll to page 4: "There are three different types of such notices given in different settings for specific types of care: 1. Notices of non coverage are given to eligible inpatients receiving or previously eligible for non-hospice services covered under Medicare Part A....but services no longer meet coverage guidelines...Beneficiaries in these settings never receive ABN's 2. ABN's and HHABN's....These forms are used for Part B and hospice services ONLY" 3. Payment Liability Condition 3........." In my opinion, this information supports the SNFs' continued use of the Medicare Denial of Benefits letter (the one we have always used) for Medicare "cut" purposes and not switching to the ABN 10055 form for that purpose. But I do think that this new information about the 10055 form is confusing. For now, we are sticking with the Denial of Benefits Notice until definite direction to the contrary (clarification) is received from the FI. One term that I've never heard of (under the number one instruction) is "Sarasett notice". Has anyone ever heard of this term? Thank you, Winona Phelps -----Original Message----- From: Sue Junot [mailto:[EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 1:20 PM To: [EMAIL PROTECTED] Subject: Re: Denial Notices so does the cms10055 (SNFABN)replace the DETERMINATION ON ADMISSION AND THE DETERMINATION ON CONTINUED STAY FORMS SUE >From: "Corey" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: <[EMAIL PROTECTED]> >Subject: Re: Denial Notices >Date: Tue, 2 Dec 2003 13:27:44 -0500 > >Denial Notices > ----- Original Message ----- > From: Joanne Stutesman > To: [EMAIL PROTECTED] > Sent: Tuesday, December 02, 2003 1:24 PM > Subject: Denial Notices > > > Could someone point me to the resource for denial notices? > Specifically, can they be dated/issued on the last covered day, or >must >they be issued prior to the LCD? > Also, I had previously asked about denial notices on admission when the >resident has no technical eligibilty, is a denial notice required on >admission in that situation? > > Thanks for any advice, > Joanne Stutesman > > _________________________________________________________________ Gift-shop online from the comfort of home at MSN Shopping! 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For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
