The SNFABN provides information to the beneficiary so that he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A). SNFs will continue to use the ABN Form CMS-R-131 when applicable for Medicare Part B items and services.
Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is: not medically reasonable and necessary; or considered custodial.
Filling the SNFABN
The SNFABN is available for download by selecting the “FFS SNFABN” link from the menu on the webpage https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html The SNFABN is a CMS-approved model notice and should be replicated as closely as possible when used as a mandatory notice. Failure to use this notice or significant alterations of the SNFABN could result in the notice being invalidated and/or the SNF being held liable for the care in question.
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SNF Information:
The SNF must include the SNF’s name, address, and phone number, at a minimum. A TTY number should be included when necessary to meet a beneficiary’s needs. Adding the SNF’s email address, additional contact information, and/or corporate logo is optional.
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Patient’s Name:
SNFs must enter the first and last name of the beneficiary receiving the notice, and a middle initial should be entered if there is one of the beneficiary’s Medicare card. The SNFABN will still be valid if there’s a misspelling or missing initial, as long as the beneficiary or their authorized representative recognizes the name listed on the notice.
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Identification Number:
Entering an identification number is optional, and the SNFABN is valid if this space is left blank. SNFs may insert an internal filing number (such as a medical record number) that might help link the notice with a related claim. Medicare numbers (i.e., Health Insurance Claim Numbers) or Social Security numbers must not be listed on the notice.
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In the blank that follows: “Beginning on…:
the SNF enters the date on which the beneficiary may be responsible for paying for care that Medicare isn’t expected to cover.
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Care Section:
In this section, the SNF lists the care that it believes may not or won’t be covered by Medicare. The description must be written in plain language that the beneficiary can understand. The care can be listed as an “inpatient stay at this facility,” for example.
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Reason Medicare May Not Pay” Section:
The SNF must give the applicable Medicare coverage guideline(s) and a brief explanation of why the beneficiary’s medical needs or conditions do not meet Medicare coverage guidelines. The reason must be sufficient and specific enough to enable the beneficiary to understand why Medicare may deny payment.
Sr. No. |
Reason Medicare May Not Pay |
| 1 | You need only assistive or supportive care. You don’t require daily skilled care by a professional nurse or therapist. Medicare won’t pay for your stay at this facility unless you require daily skilled care. |
| 2 | You don’t require the skilled care on a daily basis. Medicare won’t pay for your stay at this facility unless you need daily skilled care for your medical condition. |
| 3 | You need help with repetitive exercises and walking, and you don’t require skilled care. Medicare won’t pay for your stay at this facility unless you need daily skilled care. |
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Estimated Cost:
In this section, the SNF enters the estimated cost of the corresponding care that may not be covered by Medicare. The SNF should enter an estimated total cost or a daily, per item, or per service cost estimate. SNFs must make a good faith effort to insert a reasonable cost estimate for the care. The lack of a cost estimate entry on the SNFABN or an amount that is different than the final actual cost charged to the beneficiary does not invalidate the SNFABN. If for some reason the SNF is unable to provide a good faith estimate of projected costs of care at the time of SNFABN delivery, the SNF should indicate in the cost estimate area that no cost estimate is available. This should not be a routine or frequent practice but allows timely issuance of the SNFABN during rare instances when a cost estimate is not available.
Option Boxes
There are 3 options listed on the SNFABN with corresponding checkboxes. The beneficiary must check only one option box. SNFs are not permitted to select or pre-select an option for the beneficiary as this invalidates the notice.
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Option 1:
I want the care listed above. When the beneficiary selects Option 1, the care is provided, and the SNF must submit a claim to Medicare. The SNF must notify the beneficiary when the claim is submitted. This will result in a payment decision, and if Medicare denies payment, the decision can be appealed. SNFs aren’t permitted to collect money for Part A services until Medicare makes an official payment decision on the claim. Beneficiaries who need an official Medicare decision (Medicare denial) for a secondary insurance claim should choose Option 1.
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Option 2:
I want the care listed above, but don’t bill Medicare. When the beneficiary selects Option 2, the care is provided, and the beneficiary pays for it out-of-pocket. The SNF does not submit a claim to Medicare. Since there is no Medicare claim, the beneficiary has no appeal rights. Although Option 2 indicates that Medicare will not be billed, SNFs must still adhere to the Medicare requirements for submitting no pay bills. See Chapter 6 of the Medicare Claims Processing Manual for SNF claim submission guidance.
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Option 3:
I don’t want the care listed above. When the beneficiary selects Option 3, the care is not provided, and there is no charge to the beneficiary. Since no care is given, the SNF doesn’t submit a claim, and there are no appeal rights.
Additional Information
SNFs may use this space to clarify and/or provide any additional information they think might be helpful to the beneficiary. Information in this section will be assumed to have been made on the same date the SNFABN is issued. If the notes are made on different dates, include those dates in the notes. For example, SNFs may use this space to include:
- information on other insurance coverage, such as a Medigap policy, if applicable;
- an additional dated witness signature; or
- other necessary notes.
Signature and Date
The beneficiary or their authorized representative must sign the signature box to acknowledge that they read and understood the notice. If the beneficiary refuses to choose an option and/or refuses to sign the SNFABN when required, the SNF should annotate the original copy of the SNFABN indicating the refusal to sign and may list a witness to the refusal. The SNF should consider not furnishing the care.
Reference:
How Medical Billers and Coders Help in SNF Billing
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Ensure Compliance with Medicare Requirements
Medical Billers and Coders ensure that the SNFABN is used properly, accurately completed, and in compliance with CMS guidelines to avoid invalidation of the notice. -
Accurate Coding for Part A and B Services
Skilled nursing facility (SNF) billing requires precision in ICD-10 diagnosis codes, HCPCS codes, and revenue codes. Coders help document services in language that matches Medicare’s medical necessity standards. -
Determine Medical Necessity
We review medical records to verify whether the care provided meets Medicare’s criteria. If not, we guide SNFs in properly issuing an SNFABN and coding accordingly. -
Support in Cost Estimation
Billers assist in estimating the daily or total cost of the non-covered services, making it easier for SNFs to deliver transparent billing to patients. -
Timely Claims Submission
For Option 1 selections, coders and billers ensure accurate and timely claims submission to Medicare, reducing delays in payment decisions. -
Handling Option 2 & No-Pay Bills
If a patient opts for care without billing Medicare, billers still manage “no-pay” bills as required by CMS regulations, ensuring all documentation is in place. -
Minimize Denials and Appeals
Expert billers reduce the chances of denial by ensuring the SNFABN includes valid reasons and that claims are submitted with proper documentation. If Medicare denies the claim, they also help initiate appeals. -
Protect the SNF from Liability
A properly executed SNFABN, supported by billing and coding experts, protects the SNF from financial liability when Medicare refuses payment.
What SNF Staff Must Know When Filling the SNFABN
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Include SNF name, address, and contact number
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List care in plain language (e.g., “inpatient stay at this facility”)
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Use accurate Medicare denial reasons (e.g., care not medically necessary)
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Provide estimated costs (daily or total)
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Guide patients through the 3 SNFABN options (receive and bill, receive but don’t bill, or refuse care)
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Obtain proper signature and date
Why SNF Billing and Coding Accuracy Matters
SNF Billing under Medicare Part A involves Resource Utilization Groups (RUGs) and now Patient Driven Payment Model (PDPM) classification. Coders must assign correct HIPPS codes and validate the Minimum Data Set (MDS) that affects payment levels.
In Medicare Part B, services like labs, therapies, or durable medical equipment (DME) must be coded and billed with precise CPT/HCPCS codes.
Conclusion
The SNFABN process is complex, and a single misstep can lead to payment delays or liability. This is where experienced medical billers and coders make a big impact. From compliant notice delivery to clean claim submissions and denial management, they ensure your SNF revenue cycle remains strong and compliant.
Need expert support in SNF billing and coding?
Contact Medical Billers and Coders (MBC) at 888-357-3226
FAQs
The SNFABN informs Medicare beneficiaries that certain care may not be covered by Medicare Part A and allows them to decide whether to proceed and accept financial responsibility.
SNFs must issue the SNFABN before providing care that Medicare usually covers under Part A but might not cover in a specific situation—such as when the care is not medically necessary or considered custodial.
While the SNF fills in the necessary information, the beneficiary must personally select one of the three options on the form. SNFs are not allowed to pre-select an option on their behalf.
If a beneficiary refuses to sign or select an option, the SNF should document the refusal on the form and may include a witness signature. The facility may choose not to provide the care in such cases.
Option 1: Receive the care and allow the SNF to bill Medicare (with the right to appeal if denied).
Option 2: Receive the care but do not bill Medicare (no right to appeal).
Option 3: Decline the care and incur no charges.
