Generic Notices for Expedited Reviews vs. Skilled Nursing Facility Advanced Beneficiary Notices (ABN)/Denial Letters There seems to be confusion in the provider community regarding the generic notice for expedited review and the SNF ABN or denial letter. It appears that some providers are only issuing one generic notice for both the expedited review process and the demand bill process. The generic notice does not replace the SNF ABN/denial letter. When appropriate, the provider needs to issue both notices. The generic notice is for coverage only. The ABN is for liability. The generic notice is used to notify the beneficiary that the services are not covered by Medicare. Without the ABN telling them they are liable, then you, the provider, could be liable. Claims submitted with dates of service on or after April 15, 2006 should include all required notices. Claims without the appropriate notices may be subject to a denial. Change Requests (CR) 3949 and CR 3903, which describe the expedited review process in more detail, can be viewed on CMS’s Web site. CR 3949 can be reviewed at: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3949.pdf . The Medlearn Matters for CR 3949 can be reviewed at: http://www.cms.hhs.gov/Transmittals/downloads/R632cp.pdf . CR 3903 can be reviewed at: http://www.cms.hhs.gov/Transmittals/downloads/R594CP.pdf . The Medlearn Matters for CR 3903 can be reviewed at: http://www.cms.hhs.gov/ MedlearnMattersArticles/downloads/SE0538.pdf . To view the Questions and Answers on the expedited review process, you can go to: www.empiremedicare.com/traina/partatraining.htm .
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