May 17, 2018
New SNF ABN Requirements
The purpose of the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN) is to inform a beneficiary before he or she receives services or items that may otherwise be covered that Medicare will not, or most likely will not, pay for the services or items for a particular reason. The SNF ABN allows the beneficiary to make an informed choice to either receive the services or not. The SNF ABN also allows the beneficiary the option to have the potentially non-covered charges submitted to a review by a Medicare Administrative Contractor (MAC) for payment in the form of a Demand Bill.
On March 30, 2018, CMS released Change Request (CR) 10567. This CR discontinued the five (5) previously accepted SNF denial letters. As cited by CMS, these letters, namely the Intermediary Determination of Non-coverage, the UR Committee Determination of Admission, the UR Committee Determinations on Continued Stay, the SNF Determination on Admission, the SNF Determination on Continued Stay, and the Notice of Exclusion from Medicare Benefits (NEMB-SNF) will no longer be utilized when notifying beneficiaries of potentially non-covered services or items. CMS has revised the SNF ABN, Form CMS-10055. Providers should utilize Form CMS-10055 for SNF Demand Bills. This change is effective as of April 30, 2018.
Additional information related to the revised SNF ABN can be found in the following:
- CMS MLN Matters MM10567
: Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN) - CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 30
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