The Centers for Medicare and Medicaid Services have issued clarification instructions on the use of the skilled nursing facility (SNF) Advance Beneficiary Notice (ABN) of Non-Coverage form pursuant to the Jimmo vs Sebelius settlement. The instructions cover common denial reasons why the extended care items or services are noncovered under Medicare. The SNF may use these denial paragraphs as inserts in the “Because” and “Items or Services” sections of the SNF ABN. Denial paragraphs provided by CMS include, but are not limited to, teaching and training activities – partial denial, teaching and training activities – no skilled services, teaching or training activities – little or no progress, repetitive exercises – partial denial, therapy services for overall fitness and well-being, therapy to maintain function after a maintenance program has been established, and frequency not reasonable and necessary. To access the clarification instructions, click
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