SNF Advanced Beneficiary Notice Expected in Early 2010

MacKenzie Kimball, for HealthLeaders Media , December 30, 2009

Skilled nursing facilities (SNF) have been waiting for a new advanced beneficiary notice (ABN) for years and their wait may finally be over. During the December SNF Open Door Forum, the Centers for Medicare & Medicaid Services (CMS) announced that providers should expect to see the new SNF ABN (form CMS-10055) early next year.

"The new form is currently undergoing the agency's internal approval process and should be ready to implement by the end of January," said Charlayne Vann, healthcare policy consultant at CMS.

When items or services are not expected to be covered by Medicare, SNFs must issue a beneficiary notification to the resident prior to providing the services. This notification informs the resident of his or her financial responsibility for the service. If a beneficiary notice is not issued, issued outside the time period, or is issued improperly, the SNF may be responsible to cover the cost of the service.

Unfortunately, the current beneficiary notification process can be confusing because of the multiple forms SNFs have to choose from. For example, when Part A services are ending but the resident will remain in the SNF for custodial care or therapy, SNFs can issue the SNF ABN or one of five SNF denial letters. Once use of the new SNF ABN becomes mandatory, there will no longer be the option to use the denial letters, thus simplifying the beneficiary notification process.

"We will have a transition period from the old form to the new and expect to implement mandatory use of the new form by March 2010," Vann said.

Once the new SNF ABN is approved, it will be posted on the beneficiary notices initiative page on the CMS Web site at

MacKenzie Kimball is an associate editor in the long-term care market at HCPro. She writes PPS Alert for Long-term Care and manages MDSCentral.

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