CMS Revises Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage Form

PUBLISHED: Feb 2, 2018
Relevant to: Long Term Care

The Centers for Medicare and Medicare Services (CMS) has released a newly revised Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNFABN) along with newly developed, concise and separate instructions for form completion. Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is:

  • not medically reasonable and necessary; or
  • considered custodial.

The SNFABN can also be used as a voluntary notice and replaces the Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (NEMB-SNF). There are no specific requirements for notice completion when the SNFABN is issued voluntarily, and alternatively, SNFs may develop their own written notice for care that is never covered. When the SNFABN is being issued as a voluntary notice, the beneficiary doesn’t need to select an option box or provide a signature.

SNFs are not required to give written notice prior to providing care that Medicare never covers, such as care that is statutorily excluded or care that fails to meet a benefit requirement; however, as a courtesy to the beneficiary and to forewarn him/her of impending financial obligation, SNFs are encouraged to give notice.

According to CMS, Chapter 30, Section 70 of the Medicare Claims Processing Manual revisions will be forthcoming.

The revised SNFABN will be mandatory for use on May 7, 2018.

During the interim, SNFs may continue to use the old version of the SNFABN, the Denial Letters or the NEMB-SNF, however, it is recommended that the revised SNFABN be used as soon as possible. Follow the link below for additional information.

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