The Centers for Medicare & Medicaid Services (CMS), with the assistance of their contractors, revised the Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN), Form CMS-10055, along with the form instructions. The updated SNF ABN form and instructions are now available in the download section and can be used immediately; however, they will become mandatory starting October 31, 2024.
Skilled Nursing Facilities (SNFs) must issue this notice to Original Medicare (fee-for-service – FFS) beneficiaries to inform them of potential financial liability before providing services that may not be covered. Specifically, the SNF ABN must be used when:
An item or service, typically covered by Medicare, may not be covered in this instance because it is not considered medically reasonable and necessary, or
The care provided is custodial in nature.
For Part A items and services, SNFs should use the SNF ABN as the liability notice. For Part B items and services, SNFs must use the Advance Beneficiary Notice of Non-Coverage (ABN), Form CMS-R-131. Information about the ABN can be found at the Medicare website under the ABN section.
To download the SNF ABN and accompanying instructions, please click on the appropriate link below.
Chapter 30 – Financial Liability Protections (PDF)
SNF ABN (CMS-10055) Fillable PDF (PDF)
Compliance Perspective
Issue
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is used by various healthcare providers, including independent laboratories, home health agencies, hospices, and physicians, to inform Medicare beneficiaries when Medicare payment is likely to be denied. This notice shifts potential financial responsibility to the beneficiary in these cases. For SNFs, the ABN is specifically used for Medicare Part B services. When a SNF anticipates that Medicare Part B may not cover a particular item or service, the ABN must be issued to inform the beneficiary about their potential financial liability. Detailed guidelines for issuing the ABN can be found in Section 50 of the Medicare Claims Processing Manual, 100-4, Chapter 30 (PDF).
Discussion Points
- Ensure that your facility’s policies and procedures reflect the new requirements for issuing the ABN. This includes defining when and how to issue the notice, as well as maintaining proper documentation of the issuance. Policies should also address how to handle situations where a beneficiary contests the notice or disputes the potential financial liability.
- Implement training programs to educate staff about the revised ABN form and its usage. This should include a thorough review of when and why the form should be issued, as well as how to properly complete it. Provide specific training tailored to different roles within the facility, such as billing staff, administrative personnel, and clinical staff.
- Develop an auditing process to regularly review ABN issuance for Medicare compliance, including proper documentation and adherence to new guidelines. Implement a system to track errors, analyze trends, and address issues with corrective action plans. Periodically audit to ensure smooth operation and adherence to best practices.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
