The SNF Billing provides information to the beneficiary to ensure that he is able to choose whether to receive the treatment that isn’t likely to be covered by Medicare and take on the financial accountability. SNFs are required to utilize the SNF Billing when it is applicable to SNF prospective Pay System products (Medicare Part A). SNFs can continue to utilize ABN Form cms-R-131. ABN Form cms-R-131 when applicable for Medicare Part B items and services.
Medicare demands SNFs to issue nursing home billing companies to Original Medicare which is also known as fee-for-service (FFS) patients prior to offering services that Medicare normally covers, but it may not be covered in this situation since the service is not medically appropriate and essential or is considered to be custodial.
Nursing Home Billing
Filling the SNF Billing
The nursing home billing companies are available for download by selecting the “FFS SNF Billing” link from the menu on the webpage. The nursing home billing service is a cms-approved model notice and should be replicated as closely as possible when used as a mandatory notice. In the event of a failure to utilize this notice or to make major changes to the skilled nursing home facility billing may result in the notice becoming invalid and/or it could result in the SNF being held accountable for the services of the patient.
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SNF Information:
The SNF should include the name, address, and telephone number at a minimum. A TTY number must be provided whenever it is necessary to accommodate the needs of a beneficiary. The addition of SNFs email addresses, other contact information, and/or corporate logos is not required.
Patient’s Name:
SNFs have to include the first and final name of the individual who will receive the notice. In addition, an initial middle should be entered if the beneficiary has one of the beneficiaries’ Medicare cards. It is important to note that the SNF Billing will still be valid even if the spelling is incorrect or missing initials, as long as the individual who received the notice or their authorized representative can recognize the name in the notification.
Identification Number:
Inputting an identification number isn’t required and the SNF bill is valid even in the event that this space is left empty. SNFs can include the internal number of filing (such as a Medical Record Number) to help link the notice with a claim. Medicare numbers (i.e., Health Insurance Claim Numbers) or Social Security numbers must not be mentioned in the notice. The SNF is the day on which the beneficiary could be responsible for paying for medical expenses that Medicare doesn’t expect to cover.
Care Section:
In this section, the SNF describes the type of care it believes is not or will not be covered by Medicare. The description should be written in a simple language that the beneficiary is able to comprehend. The service can be described in the form of an “inpatient stay at this facility,” as an example.
Reason Medicare May Not Pay” Section:
The SNF must present the applicable Medicare insurance guideline(s) and a short explanation of the reason why the beneficiary’s medical conditions or needs are not in line with Medicare guidelines for coverage. The reason should be convincing and precise enough for the beneficiary to comprehend the reason Medicare could deny payment.
Reason Medicare May Not Pay
- You require only help or support. You do not require ongoing skilled care provided by a trained nurse or therapy. Medicare will not pay for the time you spend in this facility unless it is necessary to receive regular skilled treatment.
- You don’t need professional care on a regular basis. Medicare will not pay for the time you spend in this facility unless you require everyday skilled treatment to treat your medical illness.
- You require help in walking and exercises that are repetitive but don’t require expert medical attention. Medicare doesn’t cover the time you spend in the facility unless you require regular professional medical attention.
Estimated Cost:
In this section, the SNF includes the estimated cost of related care, which might have been not covered under Medicare. The SNF must include an estimate of the total cost, or each day, item, or per service estimate. SNFs should make a good attempt to provide an appropriate cost estimate for care. The absence of an entry for a cost estimate on SNF Billing or an amount that is not in line with the actual amount paid to the beneficiary is not a reason to render the validity of the SNF Billing.
If, for any reason, the SNF cannot provide a reliable estimate of the projected cost of healthcare at the moment of SNF Billing and the SNF must state in the area for cost estimates that there is no cost estimate available. This shouldn’t be a common procedure, but it allows for timely delivery SNF Billing in the rare cases where a cost estimate cannot be found.
Option Boxes
There are three options within the nursing home medical billing with corresponding checkboxes. The beneficiary is required to select only one box. SNFs cannot select or pre-select a selection for the beneficiary since it invalidates the notice.
Option 1:
I would like the services listed above. If the beneficiary chooses Option 1, the care is given by the SNF, then the SNF must submit a claim form to Medicare. The SNF must inform the beneficiary that the claim is made. The beneficiary will receive an approval of the payment, and should Medicare decline payment the decision is able to be appealed. SNFs can’t pay for Medicare Part A Services until Medicare decides to issue an official decision regarding the payment of the claim. Patients who require the official Medicare ruling (Medicare denial) to settle an insurance claim that is secondary should opt for 1. 1.
Option 2:
I’d like to receive the services listed above, but I’m not able to charge Medicare. If the patient chooses option 2 and the service is given by the beneficiary, they pay the expense out-of-pocket. The SNF is not able to file a claim with Medicare. Because there isn’t a Medicare claim and the beneficiary is not entitled to recourse rights. While Option 2 states that Medicare is not being charged, SNFs still must comply with Medicare guidelines for submitting claims that do not bill for payment. Refer to chapter 6 in the Medicare Claims Processing Manual for SNF claims submission guidelines.
Option 3:
I do not wish to receive the services mentioned above. If the beneficiary chooses option 3 care is not offered, and there is no cost for the beneficiary. Since there is no care and no care is provided, the SNF does not file an appeal and there aren’t appeal rights.
Additional Information
SNFs are able to use this area to clarify or provide additional information they believe would be useful to the beneficiary. This section of information is presumed to have been provided on the same day that the SNF Billing is issued. If the notes were made on different dates, you must include dates on the notes. For instance, SNFs may use this space to include:
- details about other insurance coverage, for example, the Medigap policy If applicable,
- An additional, dated witness signature is an additional signature of a witness
- Other notes you may need.
Signature and Date
A beneficiary or a designated representative has to fill out the box in order to confirm that they have comprehended and read the notice. If the person refuses to select an option or does not sign an SNF Billing when it is required, the SNF must annotate the initial copy of the SNF Billing to indicate the reason for the refusal and could include a witness to the refusal. The SNF may decide not to provide the service.
