03/14/2024
Survey Tip of the Week: Beneficiary Notice Review
The beneficiary notice review is a mandatory task of the Long-Term Care Survey Process. Surveyors will ask for a list of Medicare beneficiaries who were discharged from a Medicare covered Part A stay with benefit days remaining in the past 6 months. The facility must also identify who was discharged home or remained in the facility. LeadingAge Ohio encourages providers to identify the specific EMR report that includes this required information and ensure more than one individual knows how to pull the report. This will ensure compliance with the required entrance conference worksheet timeframes.
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 residents through notices given by the facility. This survey protocol is intended to evaluate a nursing home’s compliance with the requirements to notify Medicare beneficiaries when the provider determines that Medicare Part A coverage is ending or when services may no longer be covered. This review confirms that residents receive timely and specific notification when a facility determines that a resident no longer qualifies for Medicare Part A skilled services when the resident has not used all the Medicare benefit days for that episode. This review does not include Admission notifications or Medicare Part B only notifications.
The two forms of notification that are evaluated in this review are:
- Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN)—Form CMS-10055; and
- Notice of Medicare Non-coverage (NOMNC) -- Form CMS-10123.
The SNF Beneficiary Notification Review survey pathway includes a tool for surveyors to identify which forms would have been required to be completed for different scenarios. This survey pathway can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. The State Operations Manual Appendix PP provides additional guidance on beneficiary notices under F-tag 582.
LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.
For more information about the updated requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the March 13 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.
