SNF Notices Of Non-Coverage Cheat Sheet

Scenario What Notice(s) To Give Required? When To Give Notice
Beneficiary drops to a non-skilled level of care
  • Benefits have not exhausted
  • Beneficiary remains in the facility (Medicare certified bed OR non-Medicare certified bed)
SNFABN (CMS 10055) or SNF Denial Letter
AND
Notice of Medicare Non-
Coverage (NOMNC)
(CMS 10123)
Yes No later than 2 days before covered services end
Services constitute custodial care SNFABN (CMS 10055) or SNF Denial Letter
OR
Revised ABN
(CMS-R-131)
Yes Prior to providing services
SNF feels Part A services are not medically reasonable and necessary SNFABN (CMS 10055) or
SNF Denial Letter
Yes Prior to providing services
Benefits have exhausted SNF NEMB
(CMS 20014)
No Prior to benefits exhausting
  • No Qualifying Hospital Stay (QHS)
  • Did not meet 30 day transfer requirement
SNF NEMB
(CMS 20014)
No Prior to providing services
  • SNF feels Part B services are not medically reasonable and necessary, OR
  • Preventive service exceeds frequency limitations
Revised ABN
(CMS-R-131)
Yes Prior to providing services
Part B service is either
  • Statutorily excluded from coverage under Medicare, OR
  • Fails to meet a technical benefit requirement
Revised ABN
(CMS-R-131)
No Prior to providing services
Beneficiary chooses to terminate services, not the SNF None N/A N/A
Beneficiary drops to a non-skilled level of care
  • Benefits have not exhausted
  • Beneficiary goes home
Notice of Medicare Non-
Coverage (NOMNC)
(CMS 10123)
Yes No later than 2 days before covered services end
All Part B services on a plan of care are ending Notice of Medicare Non-
Coverage (NOMNC)
(CMS 10123)
Yes No later than 2 days before covered services end
Beneficiary requests expedited review from the QIO Detailed Explanation of Non-
Coverage (DENC)
(CMS 10124)
Yes As soon as notified beneficiary requested QIO review

Page Last Updated: Wednesday, 17-Apr-2013 15:06:15 CDT