FFS SNF ABN
What's New
08/28/2024: With the help of our contractors, we revised the SNF ABN, Form CMS-10055, and the form instructions. The SNF ABN form and instructions are located in the download section and are available for immediate use, but will be mandatory for use on 10/31/2024.
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.
To download the SNF ABN and accompanying instructions, please click on the appropriate link below.
Questions?
Questions regarding the SNF ABN or ABN can be submitted at: https://appeals.lmi.org/
Downloads
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Chapter 30 - Financial Liability Protections (PDF) -
SNF ABN Instructions (PDF) -
SNF ABN (CMS-10055) (PDF) -
SNF ABN (CMS-10055) Fillable PDF (PDF)