MDS Alert

Published on Mon Apr 09, 2018 PDF

Revised rules may trip up payment.

Remember: The newly revised SNF Advance Beneficiary Notice (SNFABN) requirements go into effect soon. The Centers for Medicare and Medicaid (CMS) are discontinuing the five SNF denial letters, as well as the Notice of Exclusion from Medicare Benefits – Skilled Nursing Facility (NEMB-SNF), the CMS website states. The revised SNFABN rules will become requirements by May 7, 2018. In the remaining weeks, SNFs can continue to utilize the old version of SNFABN, the website says, though CMS recommends using the new SNFABN as soon as possible. The new SNFABN looks similar, with three different options available for original fee for service (FFS) Medicare beneficiaries to choose between.

Brush up on the basics

The CMS website offers instructions on how to fill out the revise SNFABN form. The instructions include these nuts-and-bolts reminders for how to best navigate the revised rules: "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 provides information to the beneficiary so that s/he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A). SNFs will continue to use the ABN Form CMS-R-131 when applicable for Medicare Part B items and services."

You are not legally responsible to provide written notice for patients and residents, but CMS encourages extending that courtesy.

"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," says the instructions form for the revised SNFABN requirements, which you can access at the link at the end of this story.

Resource: You can access the new SNFABN form, as well as detailed instructions, by visiting the CMS website at this link: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-SNFABN-.html.