Medicare Basic Training Part 9: Beneficiary Notices Initiative On-Demand Workshop-Medicare Basic Training Part 9

Video Transcription

Video Summary

This training module covers the Beneficiary Notices Initiative (BNI) related to Medicare benefits ending in skilled nursing facilities (SNFs). Medicare requires specific notices to inform beneficiaries when coverage will end, shifting financial responsibility to them, and to explain their appeal rights. Two main processes exist: the expedited determination process and the standard denial process.<br /><br />The expedited process involves the Notice of Medicare Non-Coverage (NOMNC) and the Detailed Explanation of Non-Coverage (DENC). The NOMNC must be issued at least two calendar days before Medicare services end to notify beneficiaries of termination and appeal options. If an appeal is requested, the DENC is provided with detailed reasons for non-coverage. These notices apply to Medicare Parts A, B, and Medicare Advantage plans.<br /><br />The standard denial process uses the Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) for Medicare Part A and the ABN-R131 for Part B therapy reductions or discontinuations. The SNF ABN informs beneficiaries when care may not be covered and outlines options, including whether to accept care and bill Medicare, pay out of pocket, or refuse care.<br /><br />Proper execution of these notices—including timely delivery, accurate completion, obtaining signatures, and detailed documentation—is critical to compliance and avoiding provider liability. Updated forms and instructions effective January 2025 and October 2024 respectively, must be used. Facilities must maintain records and may face survey scrutiny on this process. Additional resources and examples are available on CMS.gov and professional community forums.

Keywords

Beneficiary Notices Initiative

Medicare coverage

Skilled Nursing Facilities

Notice of Medicare Non-Coverage

Detailed Explanation of Non-Coverage

Skilled Nursing Facility Advance Beneficiary Notice

Medicare Part A and B

Appeal rights

CMS compliance