Tips for Navigating Beneficiary Notices



CMS Beneficiary Notices have been a requirement for over a decade. There have been recent form changes for dual-eligible (Medicare Part A and B) residents and citations noted which has prompted us to send these tips out to ensure the appropriate team members are aware of the requirements and forms facilitating sound systems for compliance. Following are tips for simplification of the process for completion consistent with CMS guidelines: Situation 1. Provider elects to discontinue Medicare service provider under Medicare Part A or B Provider Responsibility: Issue NOMNC at least 48 hours prior to a service discontinuation Situation 2. Resident requests appeal of provider decision to discontinue service under Medicare Part A or B Provider Responsibility: Issue DENC to detail the reason for discontinuation - If Part A, issue SNF ABN (CMS-10055); follow special instructions for dual-eligible beneficiaries - If Part B, issue FFS ABN (CMS-R-131); follow special instructions for dual-eligible beneficiaries

Situation 3. Resident has remaining Part A benefit available upon provider discontinuation of service Provider Responsibility: Issue SNF ABN (CMS-10055); follow special instructions for dual-eligible beneficiaries Please find the direct link to CMS resources for Beneficiary Notices here, https://www.cms.gov/Medicare/Medicare-General-Information/BNI


Let's Get to the Point:

Providers should review facility processes surrounding Beneficiary Notices for CMS compliance. QRM is here to assist with questions.