(Medicare Claims Processing Manual)

Medicare Beneficiary Identifier (MBI) -  is a general term describing a beneficiary's  Medicare identification number.  Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that  will continue to use the HICN as part of their processes.    Medicare Contractor -  An entity that contracts with the Federal government to review and/or adjudicate claims, determinations and/or decisions.     Medicare Outpatient Observation Notice (MOON, Form CMS -10611) - A standardized notice to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or CAH.     Notice of Medicare Non -Coverage (NOMNC, Form CMS -10123) -  FFS Expedited Determination Notices that informs beneficiaries on how to request an expedited determination from their Quality Improvement Organization (QIO) and gives beneficiaries the opportunity to request an expedited determination from a QIO.     Overpayment Recovery Waiver  An allowance providing that beneficiaries, healthcare providers, and suppliers can keep Medicare overpayments (in certain circumstances) if they are determined to be without fault for causing the overpayment, in accordance with Section 1870 of the Soci al Security Act.  For more information, see 100- 06 Medicare Financial Management Manual, Chapter 3, Overpayments.     Refund Requirements (RR) for Non -assigned Claims for Physicians Services -  Under 9332(c) of OBRA 1986 (P.L. 99- 509), which added 1842(l) to the Social Security Act, new liability protections for Medicare beneficiaries affect nonparticipating physicians.     Refund Requirements (RR) for Assigned and Non- assigned Claims for Medical  Equipment and Supplies  Under 132 of SSAA -1994 (Social Security Act  Amendments of 1994, P.L. 103- 432) which adds 1834(a)(18) to the Social Security Act, and under 133 of SSAA -1994 which adds 1834(j)(4) and 1879(h) to the Social Security Act, new liability protections for Medicare beneficiaries affect suppliers of medic al equipment and supplies.  All suppliers who sell or rent medical equipment and supplies to Medicare beneficiaries are subject to the refund provisions of 1834(a)(18), 1834(j)(4) and 1879(h) of the Social Security Act.     Skilled Nursing Facility Advance Notice of Non -coverage (SNF ABN, Form CMS - 10055)  Issued in order for a Skilled Nursing Facility (SNF) to transfer financial liability to an Original Medicare beneficiary for items or services, paid under the SNF PPS, that Medicare is expected to deny payment (entirely or in part).     Supplier  Unless the context otherwise requires, a physician or other practitioner, a facility, or entity (other than a provider of services) that furnishes health services covered by Medicare.                              Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12423CP  12/20/2023  Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92  01/02/2024  13222  R11210CP  01/21/2022  Expedited Review Process for Hospital Inpatients in Original Medicare  04/21/2022  12546 R10862CP  07/14/2021  Section 50 in Chapter 30 of Publication (Pub.) 100- 04 Manual Updates  10/14/2021  12242 R4197CP  01/11/2019  Chapter 30 Revisions in Publication (Pub.) 100-04, Medicare Claims Processing Manual  04/15/2019  10848 R4250CP  03/08/2019  Update to Chapter 30 in Publication (Pub.) 100-04 to Provide Language -Only Changes for the New Medicare Card Project  04/08/2019  11165 R4198CP  01/11/2019  Skilled Nursing Facility Advance Beneficiary Notice of Non -Coverage (SNF ABN)  04/30/2018  10567 R4001CP  03/16/2018  Internet Only Manual Updates to Pub. 100-01, 100- 02 and 100- 04 to Correct Errors and Omissions (SNF) (2018)  06/19/2018  10512 R4011CP  03/30/2018  Skilled Nursing Facility Advance Beneficiary Notice of Non -Coverage (SNF ABN) - Rescinded and replaced by Transmittal 4198  04/30/2018  10567 R3698CP  01/27/2017  Medicare Outpatient Observation Notice (MOON) Instructions  02/21/2017  9935 R3695CP  01/20/2017  Medicare Outpatient Observation Notice (MOON) Instructions   Rescinded and replaced by Transmittal 3698 02/10/2017  9935 R3560CP  07/15/2016  Correction of Remark Code Information  10/17/2016  9641 Rev #  Issue Date  Subject  Impl Date  CR#  R3187CP  02/06/2015  Language Only Update to Pub 100- 04, Chapter 30 for ASC X12 and Claim References  03/06/2015  8992 R2911CP  03/14/2014  Manual Updates to Clarify Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) Requirements Pursuant to Jimmo vs. Sebelius  03/25/2014  8644 R2878CP  02/21/2014  Correction CR -  Advance Beneficiary Notice of Noncoverage (ABN), Form CMS -R-131 05/15/2014  8597 R2782CP  09/06/2013  Advance Beneficiary Notice of Noncoverage (ABN), Form CMS -R-131 12/09/2013  8404 R2781CP  09/06/2013  Home Health Change of Care Notice (HHCCN), Form CMS -10280, Manual Instructions.  This CR rescinds and fully replaces CR 7323. 12/09/2013  8403 R2711CP  05/24/2013  Expedited Determinations for Provider Service Terminations  08/26/2013  7903 R2480CP  06/01/2012  Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS -R-131, Updated Manual Instructions  09/04/2012  7821 R2362CP  12/01/2011  Home Health Advance Beneficiary Notice, (HHABN), Form CMS -R-296 02/03/2012  7323 R1983CP  06/11/2010  Clarification on Use of the SNF ABN and Denial Letters  07/12/2010  6987 R1587CP  09/05/2008  Revised Form CMS -R-131 Advance Beneficiary Notice of Noncoverage  03/01/2009  6136 R1257CP  05/25/2007  Important Message From Medicare (IM) and Expedited Determination Procedures for Hospital Discharges  07/02/2007  5622 Rev #  Issue Date  Subject  Impl Date  CR#  R1186CP  02/23/2007  Changes to Chapter 30 -   Updates to Amount in Controversy Requirement and Correction of Appeals Terminology 05/23/2007  5348 R1035CP  08/18/2006  Updating Publication 100- 04, Chapter 30 Regarding the CD ROM Initiative for the Annual "Dear Doctor" Mailing  09/18/2006  5214 R1025CP  08/11/2006  Revised Home Health Advance Beneficiary Notice  09/01/2006  5009 R994CP  06/30/2006  Special Issues Associated with the Advance Beneficiary Notice (ABN) for Hospice Providers and Comprehensive Outpatient Rehabilitation Facilities (CORFs)  09/29/2006  5117 R594CP  06/24/2005  Preliminary Instructions: Expedited Determinations/ Reviews for Original Medicare  07/01/2005  3903 R577CP  06/03/2005  Preliminary Instructions: Expedited Determinations/Reviews for Original Medicare  07/01/2005  3903 R001CP  11/01/2003  Initial Publication of Manual  NA NA Back to top of Chapter