Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®
Friday, March 30, 2018, CMS posted Transmittal #R4011CP and the corresponding MLN Matters -MM10567 to inform SNFs billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries that the “Centers for Medicare & Medicaid Services (CMS) has revised the Skilled Nursing Facility Notice of Noncoverage (SNF ABN), Form CMS-10055. With this revision, CMS is discontinuing the five Skilled Nursing Facility (SNF) Denial Letters (namely, the Intermediary Determination of Noncoverage, the UR Committee Determination of Admission, the UR Committee Determination on Continued Stay, the SNF Determination on Admission and the SNF Determination on Continued Stay), and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS20014. Please ensure that your billing staffs are aware of these changes.
Please note that the Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123 is not being discontinued with this revised SNF ABN. More information on the NOMNC is available at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-Expedited-Determination-Notices.html.
SNFs will continue to use the Advance Beneficiary Notice of Non-coverage (ABN, Form CMSR-131) for items or services that Medicare may be deny under Medicare Part B. Please note that SNFs may start to implement this new notice any time up to the implementation date of CR10567. Upon the CR10567 implementation on April 30, 2018, the use of the new notice is mandatory. The revised notice incorporates suggestions for changes made by users of the ABN and by beneficiary advocates based on experience with the current form, refinements made to similar liability notices through consumer testing and other means, as well as related Medicare policy changes and clarifications.”
This transmittal overrides the late January posting that mandated the use of the CMS-10055 beginning May 7, 2018. SNF providers must now start issuing the revised CMS-10055 as of April 30, 2018 if not before.