Quiz: BNI's - NOMNCs & ABNs - What and When to Issue - Montero Therapy and MDS Services

1. Question

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

To inform residents of a potential financial liability and allow them to decide if they want to receive the services
To allow resident to access appeal rights when services are ending
Both of the above
None of the above

2. Question

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 longer medically necessary?

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

SNF ABN
OBRA 87
NOMNC
All the above are issued

3. Question

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

To tell the resident how much they will need to pay when the covered services end
To tell the resident they have a right to appeal the decision to end Medicare services
To give the resident the name and phone number of who to call in order to appeal the facility's decision to cut Medicare
To document that 2 days advanced notice was given to the resident and that they were made aware of the last covered Medicare day

4. Question

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?

SNF ABN CMS-10055 (Advanced Beneficiary Notice); An explanation of why the Medicare services are ending
DENC CMS-10124 (Detailed Explanation of Non-Coverage); Detailed explanation of why the Medicare services are ending
COT OMRA; Explanation of why the Medicare services are ending
All of the above

5. Question

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….

To provide the resident with the date of the last covered Medicare day
To give the resident the chance to appeal
To inform the resident that Medicare will no longer pay for the services, allow the resident the opportunity to elect to continue the services, and provide a cost estimate.
None of the above

6. Question

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?

DENC CMS-10124
ABN CMS-R-131
SNF ABN CMS-10055
NOMNC CMS-10123

7. Question

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.

True
False

8. Question

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.

True
False

9. Question

Which of the following scenarios WOULD NOT REQUIRE ANY TYPE of Beneficiary Notice (use your cheat sheet for assistance).

Select ALL that apply:

The resident used 20 days of Medicare Part A and is being discharged home.
The resident used all 100 days of Medicare Part A or has exhausted all Part A days.
The resident has been receiving PT and OT under Part B and both services are ending.
The resident requests Part A therapy services to stop. The resident does not have any skilled nursing needs.
The LTC resident goes out to the hospital and returns after a 2-night stay. Therapy will begin 5 days per week.
The resident requests an appeal when notified of the last covered Part A day.
The resident left the SNF against medical advice (AMA).

10. Question

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

How many levels are in the Appeals Process?

2
3
4
5

Quiz: BNI’s – NOMNCs & ABNs – What and When to Issue

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