S and C Issues Related to Liability Notices and Beneficiary Appeal Rights in Nursing Homes

This memorandum reviews a Skilled Nursing Facility (SNF) provider's obligations to issue Medicare beneficiary liability notices, a Medicare beneficiary's rights related to standard claim and expedited appeals; and the surveyor's responsibility to determine compliance with Medicare notice and billing requirements for determinations of non-coverage. The SNF provider must inform the beneficiary of potential liability for payment for non-covered services when limitation of liability applies. The SNF must provide a written notice to the Medicare beneficiary explaining his/her right to file an expedited appeal upon termination of all Medicare covered services. Appendix P of the SOM, Survey Protocol for Long Term Care Facilities, Part VII will be deleted. The information in this memo will be moved to Sub-Task 5C and a new section on Liability Notices and Beneficiary Appeal Rights will be created. This memo does not apply to beneficiaries with Medicare Advantage.