I am confused, for some reason I was dropped from the discussion group over
the holidays and just got signed up again, so I may have missed part of the
history of this discussion.

Why is the SNF taking on the responsibility of notifying the Medicare + C
beneficiary of non-coverage? Having worked in the home of the HMO's-
Minnesota for more than 25 years- the SNF's have not taken on the
responsibility of giving the HMO denial notices. In some facilities we have
used a form letter that indicates:

On ___/___/ _____, your Medicare HMO
_________________________________________, advised us that the services you
receive will no longer quality as covered beginning ___/___/_____.

The Medicare HMO will send you a formal determination as to the noncoverage
of your stay after ___/___/_____. If you wish to appeal, the formal notice
will contain information about how this can be done. The intermediary will
inform you of the reason for denial and your appeal rights.


If you read the instructions I have cut and pasted below- for Medicare C
beneficiary notices- it seems clear to me that the responsibility is that of
the M+CO not the SNF.

As a former administrator, I would not have my staff issuing the HMO
non-coverage letter or signing such documents. This is not a decision that
has been made by the SNF- the SNF is only relaying the information.

Theresa Lang
Specialized Medical Services, Inc.


Per the CMS BNI- Website http://www.cms.hhs.gov/medicare/bni/

Instructions for the CMS10003-NDP (Notice of Denial of Payment)
A Medicare+Choice Organization (M+CO) is to complete and issue this notice
when it denies a M+C enrollee's request for payment of a service already
received. This is not model language. This is a standard form.

Instructions for the CMS10003-NDMC(Notice of Denial of Medicare Coverage)
A Medicare+Choice Organization (M+CO) is to complete and issue this notice
when it denies a M+C enrollee's request for medical service. This is not
model language. This is a standard form. M+COs may not deviate from the
content of the form provided.

Notice of Medicare Non-Coverage �The Advance Notice�
CMS-10095-A
A Medicare+Choice (M+C) provider must give an advance, completed copy of
this notice
to enrollees receiving skilled nursing, home health or comprehensive
outpatient
rehabilitation facility services not later than two days before the
termination of services.
This notice fulfills the requirement at 42 CFR 422.624(b)(2).
This is a standard notice. M+C providers should not deviate from the content
of the form
except where indicated.

�DETAILED EXPLANATION OF NON-COVERAGE�
CMS-10095-B
A Medicare+Choice (M+C) organization must provide a completed copy of this
notice to
enrollees receiving skilled nursing, home health or comprehensive outpatient
rehabilitation facility services upon notice from the Quality Improvement
Organization
(QIO) that the enrollee has appealed the termination of services in these
settings. This
notice fulfills the requirement at 42 CFR 422.626(e)(1), and must be
provided no later
than close of business of the day of the QIO�s notification.

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of
[EMAIL PROTECTED]
Sent: Thursday, January 01, 2004 8:12 AM
To: [EMAIL PROTECTED]
Subject: New appeals regulation


I was able to find out about what I thought were new regs regarding snf
denial letters.I found out ithas to do with managed medicare
programs.Apparently there was a class action lawsuit brought by enrolles in
medicare risk based programs.They felt the companies failed to give them a
fair termination process.In Mass as of Jan 1st,our Medicare Quality
Improvement Organization will conduce any appeals.The snf will now need to
give the beneficiary an advanced 48 hour notice before the managed care
company does..I won't get into all the details but I am sure it may differ
state to state.We deal with several M-C organizations but only 1 has
discussed this with us.I guess as usual,the snf has to take the lead.

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/----------------------------------------------------------
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
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