Using Quality in Focus as the foundation, Polaris Group highlights FTag 582 Medicaid/Medicare Coverage/Liability Notice.
CMS developed the Quality in Focus Program as a resource for all long-term care facilities across the country to assist in the promotion of safe environments within LTC facilities and educate the general public about why regulations in nursing facilities seem strict and sometimes restrictive. Using Quality in Focus as the foundation, Polaris Group highlights FTag 582 Medicaid/Medicare Coverage/Liability Notice.
Medicare beneficiaries have specific rights and protections related to financial liability and the right to appeal a denial of Medicare Services under the Medicare Program. These financial liability and appeal rights and protections are communicated to policyholders through notices given by providers. Facilities are required to meet the requirements in determining when Medicare Part A coverage is ending or when services may no longer be covered and communicate notice of termination via forms created by CMS.
What’s new regarding beneficiary notices? In November 2024, CMS renewed the Notice of Medicare Non-Coverage (NOMNC, CMS) and the Detailed Explanation of Non-Coverage (DENC, SMC 10124). The renewed notices contain updates that apply only to Medicare Advantage enrollees. Facilities must use the current notices until December 31, 2024, and must use the new NOMNC and DENC beginning January 1, 2025.
To download the SNF ABN and accompanying instructions, click the appropriate links below.
Guidelines for notice issuance:
SNF ABN required:
- Resident has skilled benefit days remaining, is being discharged from Part A services, and wishes to continue services and continue to live in facility, realizing they may be charged for services.
NOMNC required:
- Resident has skilled benefit days remaining, is being discharged from Part A services, and is leaving the facility immediately following the last covered skilled day
- Resident has skilled benefit days remaining, is being discharged from Part A services, and will continue to live in the facility.
No Notice required:
- Resident has benefit days remaining and elects Hospice benefit.
- Resident discharges self as an unplanned discharge.
- Resident has an unplanned discharge to the hospital.
- Resident discharged to another SNF for continued skill care.
- Resident exhausts their Part A benefits and has no days remaining.
Facility action steps:
- Ensure personnel directed to issue notices are educated regarding when a NOMNC and/or a SNF ABN is issued.
- Audit records for beneficiaries who received a termination of services notices since the last survey.
- Educate staff to complete the form in its entirety and maintain proof of notice.
- Educate staff that the facility may not charge the beneficiary for Part A services during the demand bill process.
- Review policies and processes related to NOMNC and SNF ABN termination conditions and notices.
For further information about our Polaris Group Medicare audits to better ensure compliance with F582, please utilize our Contact Us page!
