Quiz: Audits, Beneficiary Notices & Compliance for SNF Therapy Professionals

What are the main purposes of all the Beneficiary Notices issued to residents in the SNF? (Check all that apply)

What is the name of the Beneficiary Notice given to residents who have an end in their Medicare Part A coverage  because the facility states the coverage is no loner medically necessary? 

It is the form that is given whether the resident is staying long-term or has a planned discharge from the SNF.

The main purposes of the NOMNC CMS-10123 (Notice of Medicare Non-Coverage) is all EXCEPT WHICH ONE:

A SNF resident receives a NOMNC CMS-10123 informing them of an upcoming cut from Medicare Part A by the facility. The resident has days left in their benefit period (100 day bank).

The resident informs the facility that they plan to appeal the decision.

What form must the facility issue to the resident immediately, and what information is on the form?

The Beneficiary Notice Initiative (BNI) is the umbrella term for all the notices that are issued to Medicare residents regarding their coverage.

The ABNs are a group of notices under the BNI umbrella.

The primary purpose of any of this group of Advanced Beneficiary Notices (SNF ABN CMS-10055 and ABN CMS-R-131) is….

A resident is cut from Medicare Part A and issued a NOMNC CMS-10123.

The resident plans to stay in the facility long term, or for at least 1 additional day after Medicare ends.

What is the form that needs to be issued to the resident on or before their last covered day?

The Beneficiary Notice required for residents coming off all Part B therapy programs is called the NOMNC.

This form gives the resident advanced notice and allows for them to appeal the decision.

The rule is to issue the form at least 2 calendar days in advance, not 48 hours.

The reason a facility would issue a mandatory CMS ABN-R-131 to a Medicare Part B resident is if the resident requested continued services after the therapist determined they were no longer medically necessary AND the facility decides to provide additional services and continue to bill Medicare. When Medicare denies coverage for the services, the facility is allowed to bill the resident.

The CMS ABN-R-131 can be given on a voluntary basis as a means of documented communication with the resident for charges they will incur when services are provided that Medicare never covers.

Medicare Part A and Part B residents records are selected for medical record reviews based on data patterns that trigger the need for further review.

Billing patterns that are seen as outliers from other similar providers in the area or nation often trigger a record review.

Both SNF providers and SNF residents are entitled to appeals of denied claims or services.

How many levels are in the Appeals Process?