Reason Code: 55S05
Error Description:
The documentation submitted supports that the services are not covered by Medicare. The beneficiary received a valid SNF ABN; thus, the beneficiary is liable for the noncovered charges on this claim.
Avoiding/Correcting this Error
The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services accordingly.
Related Content
- CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 30 – Financial Liability Protections
- Section 50 – Advance Beneficiary Notice of Non-coverage (ABN)
- Section 70 – Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN)
- CMS Medicare FSS SNF ABN
- CMS MLN Matters article MM10567, Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN)
- CMS MLN Booklet, MLN006266, Medicare Advance Written Notices of Non-coverage