As a Medicare beneficiary or provider, it is important to understand your rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) programs. These rights and protections are communicated to beneficiaries through notices given by providers.
One type of notice is the FFS Advance Beneficiary Notice of Noncoverage (FFS ABN). This notice is used by providers to inform a Medicare beneficiary that a particular healthcare service may not be covered by Medicare, and that the beneficiary may be financially responsible for the cost of the service. The notice is typically given to the beneficiary before the service is provided, so that they can make an informed decision about whether to proceed with the service. If the beneficiary chooses to proceed with the service, they will be asked to sign the notice, which acknowledges their understanding of the financial responsibility.
Another type of notice is the FFS Home Health Change of Care Notice (FFS HHCCN). This notice is used by Medicare-certified home health agencies to inform a Medicare beneficiary that there will be a change in their plan of care, and that the change may affect their Medicare coverage and financial responsibility. The notice is typically given to the beneficiary at least two days before the change is made, so that they can make an informed decision about whether to continue receiving the service.
The FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNF ABN) is used by skilled nursing facilities to inform a Medicare beneficiary that their Medicare coverage for skilled nursing care may be ending soon, and that they may be financially responsible for the cost of the care. The notice is typically given to the beneficiary at least two days before the coverage ends, so that they can make an informed decision about whether to continue receiving the care.
FFS Hospital-Issued Notices of Noncoverage (FFS HINNs) are used by hospitals to inform a Medicare beneficiary that a particular healthcare service may not be covered by Medicare, and that the beneficiary may be financially responsible for the cost of the service. The notice is typically given to the beneficiary before the service is provided, so that they can make an informed decision about whether to proceed with the service.
FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility (FFS Expedited Determination Notices) are used by providers to inform a Medicare beneficiary that their Medicare coverage for a particular healthcare service is ending soon, and that they have the right to an expedited determination of their appeal if they disagree with the decision. The notice is typically given to the beneficiary at least two days before the coverage ends, so that they have time to file an appeal if they choose to do so.
MA Denial Notices (MA Denial Notices) are used by Medicare Advantage plans to inform a beneficiary that a particular healthcare service is not covered by their plan, and that the beneficiary may be financially responsible for the cost of the service. The notice is typically given to the beneficiary before the service is provided, so that they can make an informed decision about whether to proceed with the service.
MA Expedited Determination Notices (MA Expedited Determination Notices) are used by Medicare Advantage plans to inform a beneficiary that their Medicare coverage for a particular healthcare service is ending soon, and that they have the right to an expedited determination of their appeal if they disagree with the decision. The notice is typically given to the beneficiary at least two days before the coverage ends, so