Q&A: Medicare SNF Benefit

Q: I have a question about navigating the skilled nursing facility (SNF) benefit for Medicare. My understanding is that you can only use a Hospital-Issued Notices of Noncoverage (HINN) for inpatient, so you could use if less than a three-day stay. We have been giving Advance Beneficiary Notices (ABN) for our traditional Medicare patients that are observation when families are not timely on getting a SNF secured to those patients that require it. Is this correct?

A: HINN1 is known as a preadmission/admission HINN and can be given prior to a hospital stay when it is expected that the entire stay will be denied for coverage. So if a patient was brought to the hospital ED for the purpose of SNF placement and the physician is writing an order to admit to inpatient, many hospitals have their ED case manager intervene by giving the patient and family the HINN1. The physician does not have to agree with the issuance of the denial notice. Seeing the denial notice often convinces the patient and family to choose another plan of care for the patient and no admission takes place.

For patients placed in observation, ABNs are used for Medicare Part B outpatient services when it is believed Medicare will no longer pay for the services it normally would cover. Some common reasons one would issue an ABN include when services are not reasonable and necessary or when the care is custodial. So if the family hasn't moved fast enough to take that available SNF bed and the patient's care is considered custodial, it is correct to issue the ABN. For more information, see Medicare Advance Beneficiary Notices, October 2015, Medicare Learning Network, Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, C-ASWCM, ACSW, manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, answered this question.

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