Webinar
Overview
CMS has updated several Medicare beneficiary notice requirements in recent years. As a result, many facilities struggle to determine which notice they must provide when Medicare coverage changes or ends. Make sure your team understands the notice requirements for Medicare Part A, Medicare Part B, and Medicare Advantage situations. This presentation reviews the Medicare beneficiary notices that apply when Medicare coverage changes or ends. Participants will learn the two primary notice processes that affect resident financial liability and appeal rights.
First, the session explains the expedited appeal process. Attendees will learn the required timelines, resident rights, and notice requirements. The presentation also covers when providers must issue the Notice of Medicare Non-Coverage (NOMNC) and Detailed Explanation of Non-Coverage (DENC) for Medicare Part A, Medicare Part B, and Medicare Advantage beneficiaries.
Next, the session examines the Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN). CMS significantly revised this notice and made it mandatory on October 31, 2024. Providers must issue the SNF ABN at admission when a resident meets Medicare’s technical requirements but may not meet the clinical coverage criteria. The notice allows the resident to request a demand bill. Providers must also issue the SNF ABN when Medicare Part A coverage ends and the resident remains in the facility under another payer source.
The presentation concludes with a review of the ABN (CMS-R-131). Providers use this notice when Part B services will end or decrease and the resident wants to continue receiving those services. The resident accepts potential financial responsibility if Medicare later denies coverage. This notice does not replace the SNF ABN. Providers use it less frequently because it applies only to specific Part B situations.
Instructor
Carol Maher is a Board-Certified Gerontological Registered Nurse with over 30 years of experience in long-term care. Her extensive career includes roles as an MDS Coordinator, Senior Vice President of Utilization Services, and Director of Reimbursement for large, multi-facility organizations.
Carol was selected as one of the Gold Standard Nurses for MDS 3.0, contributing to the development of the Care Area Assessments (CAAs) through the RAP workgroup and serving on numerous Technical Expert Panels focused on MDS, Quality Measures, and care planning. She is a nationally recognized speaker, presenting regularly at AANAC, AHCA, and LeadingAge conferences, as well as for many state-level organizations. Her writing has appeared frequently in publications covering the RAI process and Prospective Payment System (PPS).
Carol served for nine years on the AANAC Board of Directors and currently sits on the AANAC Expert Advisory Panel. She is also an AANAC Master Teacher. As Director of Education at Hansen Hunter, Carol leads MDS and Medicare training sessions nationwide, presents monthly educational webinars, and conducts compliance audits. She is the author of The Long-Term Care MDS Coordinator’s Field Guide (HCPro, 2016).