SNFABN/Denial Letters

See the Resources section of my website (JudyWilhide.com)  for CMS web links for these notices.  A resident who is remaining in the Nursing Facility under another pay source after the last covered day (LCD)  on the Notice of Medicare Non-Coverage (NOMNC)  must be issued a second letter.  This letter gives the resident the right to a standard claim appeal, also known as a demand bill.  This is in addition to and not instead of the NOMNC.    You have six choices for which form to use.  You can use either the SNFABN or one of the five denial letters on the CMS website.

Judy's opinion:  Folks who use the SNFABN get more demand bills because of the poor wording on the SNFABN.  Folks who use a denial letter don't get as many demand bills.   Read the choices on the SNFABN and then read the choices on the denial letters and decide for yourself.

If you choose the denial letters, there are two of the five that are appropriate in most cases.  I have posted these two in my Resources on my website.  One is called "SNF Determination on Continued Stay."  This one is used when the resident has used some SNF Part A days and you are cutting them because they no longer meet SNF level of care (LOC)  criteria.  The second one, rare but possible, is the "Determination on Admission."  This one is used if they have a three day qualifying stay,  have days available, but do not meet SNF LOC criteria.  They have no skilled need so you never put them on Medicare.