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Beneficiary Notices Initiative (BNI)
Go to FFS FLP Notices Medicare Advantage Notices Privacy Notices BNI OVERVIEWOBJECTIVE: It is an agency objective to improve agency-to-beneficiary communications in order to further beneficiary education and health promotion, and to facilitate access to and exercise of individual rights and protections. The use of beneficiary notices is one of CMS' best opportunities to achieve successful outreach to program beneficiaries. CMS directly touches the lives of millions of beneficiaries every day by its program notices to beneficiaries. PURPOSE: The purpose of the CMS Beneficiary Notices Initiative [BNI] is to wed consumer rights and protections with effective beneficiary communication so that beneficiaries are given the opportunity to timely exercise their rights and protections in a well-informed manner. These rights and protections are both statutorily & regulatorily mandated, as well as by Executive Order, and are enunciated in various venues and formats, such as providers' Conditions of Participation, the President's Consumer Bill of Rights & Responsibilities, Privacy Act Statements, and statements of non-discrimination (the Civil Rights Act). FEATURES: BNI - improving notices to improve beneficiary communications:
Through the BNI, CMS can:
CMS has the opportunity to better serve its beneficiaries by:
Replicable Adobe Acrobat PDF files are furnished. Viewing notices in the PDF format retains the appearance most accurately. FFS FINANCIAL LIABILITY PROTECTIONS (FLP) NOTICESAdvance Beneficiary Notice [ABN], form CMS-R-131 The CMS-R-131 form is the ABN approved by OMB (Office of Management and Budget) on June 18, 2002. There are two CMS-R-131 forms, the General Use form ("ABN-G") and the Laboratory Tests form ("ABN-L"). Both CMS-R-131 ABN forms are standard forms which may not be modified.
Notice of Exclusions from Medicare Benefits [NEMB], form CMS-20007 Notices of Exclusions from Medicare Benefits (NEMBs) may be used with items and services that are excluded from Medicare benefits. NEMBs alert Medicare beneficiaries in advance that Medicare does not cover certain items and services because they do not meet the definition of a Medicare benefit or because they are specifically excluded by law; that is, when the use of an ABN is not appropriate. There is an NEMB (i.e., form CMS-20007) for general use in any case and other NEMBs customized for certain items and services. (See the draft CMS-10111 NEMB-HHA and CMS-20014 NEMB-SNF, below.)
Home Health Advance Beneficiary Notice [HHABN], form
CMS-R-296
Notice of Exclusions from Medicare Benefits - Home Health Agency [NEMB-HHA], form CMS-10111 The draft model form Notice of Exclusions from Medicare Benefits - Home Health Agency (NEMB-HHA) may be used with home health items and services that are excluded from Medicare benefits. NEMB-HHAs alert Medicare beneficiaries in advance that Medicare does not cover certain items and services because they do not meet the definition of a Medicare benefit or because they are specifically excluded by law; that is, when the use of an HHABN is not appropriate. The model form CMS-10111 is presently in OMB clearance and is not now mandatory for use by HHAs.
Skilled Nursing Facility Advance Beneficiary Notice [SNFABN], model form CMS-10055 The model form CMS-10055 is a new SNFABN form for use by SNFs and should not be modified. SNFs may begin to use the new SNFABN form immediately. The SNFABN is not now mandatory for use by SNFs.
Notice of Exclusions from Medicare Benefits - Skilled Nursing Facility [NEMB-SNF], form CMS-20014 The draft model form Notice of Exclusions from Medicare Benefits - Skilled Nursing Facility (NEMB-SNF) may be used with extended care items and services that are excluded from Medicare benefits. NEMB-SNFs alert Medicare beneficiaries in advance that Medicare does not cover certain extended care items and services because they do not meet the definition of a Medicare benefit or because they are specifically excluded by law; that is, when the use of an SNFABN is not appropriate. The model form CMS-20014 is presently in final development and is not now mandatory for use by SNFs.
Important Message from Medicare [IM], form CMS-R-193 Hospital-Issued Notices of Noncoverage [HINNs] The current model Hospital-Issued Notices of Noncoverage (HINNs) are published in the Medicare Claims Processing Manual (Pub. 100-4), Chapter 30, Section 130.9. Hospitals should use these forms to properly notify beneficiaries.
FFS Financial Liability Protections Notices Exhibits
MEDICARE ADVANTAGE NOTICESMedicare Advantage [MA] Denial Notices, form CMS-10003
Medicare Advantage Expedited Notices, form CMS-10095
PRIVACY NOTICES
OASIS Privacy Notices (Home Health Agency Outcome and
Assessment Information Set) THE CMS FORMS PAGECMS is making for informational purposes many of its Program Forms available in Portable Document Format (PDF). For your convenience, links to Optional Forms, Standard Forms, SSA Forms, and HHS Forms have also been provided.
Last Modified on Wednesday, October 06, 2004
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Centers for Medicare & Medicaid Services
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