SNF ABN (Form CMS-10055): CMS Adds New Fillable PDF Version (10/20)

By CMS - October 07, 2020

Skilled Nursing Facilities (SNFs) must issue a notice to Original Medicare (fee for service - FFS) beneficiaries in order to transfer potential financial liability before the SNF provides:

  • an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
  • custodial care.

For Part A items and services: SNFs use the SNF ABN as the liability notice.

For Part B items and services: SNFs use the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The ABN and information on this notice can be found at /Medicare/Medicare-General-Information/BNI/ABN.

Note: The SNFABN process is separate from the expedited determination process. So the SNFABN does not replace the Notice of Medicare Noncoverage (NOMNC). Each notice is used to meet the requirements of the separate processes.