CMS SNF Beneficiary Notice of Non-Coverage - SNF ABN - DIGITAL FORM
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Updated September 2020, this CMS SNF Beneficiary Notice of Non-Coverage - SNF ABN - is provided to a Part A beneficiary to inform him/her of potential liability, prior to services being provided:
•Beneficiary cannot be accepted for skilled care because Medicare is not expected to pay for items or services the physician has ordered
•When a beneficiary's skilled services will not be paid for by Medicare at the current level or frequency
•When skilled care will end because Medicare will not continue to pay for such items or services
The CMS-10055 protects the SNF from financial liability and allows the facility to bill and collect the specified charges from the beneficiary.
The SNF ABN must be delivered in writing far enough in advance to enable resident to make an informed decision.
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*This this digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.