Your rights upon admission when a skilled nursing facility (SNF) says that Original Medicare won’t pay for your care will usually depend on whether the SNF will agree to admit you anyway.
- If a SNF will not admit you as a patient because it believes that Medicare won’t pay, you must find another SNF.
- If a SNF will admit you as a patient but believes that you do not qualify for Medicare SNF coverage, you have the right to ask the SNF to bill Medicare anyway. This is called demand billing.
- When a SNF believes that Medicare will not cover your care because your health doesn’t require it or you only need personal or custodial care, the SNF must give you a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) or a form attached to a denial letter. SNFs have a choice of which document they give you.
If the SNF gives you a SNF ABN or denial letter, you will need to decide whether to:
- Turn down care—you can look for another Medicare-certified skilled nursing facility (SNF); or
- Request that the SNF submit a demand bill and agree to pay for care if Medicare denies coverage.
If you demand bill, the SNF cannot bill you until Medicare makes its payment decision. The Medicare Summary Notice (MSN), which you receive on a quarterly basis, will show Medicare’s decision. If Medicare does not pay for your SNF care, you can appeal by following the instructions on your MSN.
Note: if the SNF does not provide you an ABN and Medicare later denies care because of medical necessity, you typically will not owe the SNF for your care.