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I was given an ABN paper to read, check a box, sign and return it. I discussed it with my sibling and we agreed a certian way. Today I get an email response saying that if I don't resubmit it, with a different and specific box checked, then my mom can't stay there. Is that legal for them to do that?

My blood pressure soared when I read your post. I had to sign one of those as POA for my mom in 2022 (when she was in and out of hospitals and rehabs with extreme anxiety and unresolved pain all over her body). It shocked me because the facility and previous hospitalizations had drugged her up so thoroughly (and kept her bedridden) that she lost physical strength, mobility and balance. The COVID 10 day isolation periods everywhere she went did NOT help matters in the least, as she reads lips to understand what is being told her. Anyway they did some PT with her, but with her drugged and depressed condition she still couldn’t function so that she could safely go home. So they wanted to keep her there and have her pay privately and said they weren’t going to appeal to Medicare.

Like you I was flabbergasted to suddenly receive this notice that she would be discharged in 2 days and that they wouldn’t help me appeal. It was an eye opener for me. I had 48 hours to do it so I appealed, and was denied. And then I pulled her out on the last day while they said they wouldn’t allow it or something, and demanded that I sign some type of unsafe discharge paperwork. I was absolutely furious. She went home with me, and in two days she was back in the hospital. Funny thing, the night before she went to the hospital I got a call from Medicare saying mea culpa (or rather they blamed the facility) and Medicare said that, in retrospect, they now have approved my appeal for 12? or 20? more days. And I said “too late she’s out”. It felt like Medicare doing CYA anyway. The next morning she’s back in hospital, having taken another big fall with so many drugs in her.

Sorry for my rambling. I apologize to some of the posters here who are medical professionals and therapists etc. You understand the system much better but those of us who are “customers” can sometimes feel like we have been sucked into a meat grinder!
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MidwestOT Jan 25, 2025
No need to apologize InlandMeg. I sometimes visit a forum of healthcare providers, many of whom work in skilled nursing settings. They also feel like they’re in a meat grinder, trying to provide quality care against all odds.

My heart goes out to people that don’t understand the system, it’s hard enough when you do. That’s why I try to answer questions here when I think I know something, always to be taken with a grain of salt lol.
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I looked it up and boy have they made that form more complicated than it used to be, looks like it changed a couple years ago. I think the facility is looking for guaranteed payment as soon as possible, and appealing to Medicare would be a long process. I certainly don’t know anything about the legalities, and I’m sorry someone there hasn’t explained it to you.
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Bgreen7777 16 hours ago
Ya, too much is about the money and not about the patients care or wishes.
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Thanks Bgreen, so it sounds like it is a therapy qualification issue in a skilled nursing facility. I retired 2 1/2 years ago but if I recall correctly, in home health we had to provide the ABN at least 48 hours before agency discharge. I always tried to communicate with the client/family when I anticipated discharge from OT so that they weren’t surprised. Unfortunately, it sounds like that didn’t happen in your situation. Were you in contact with your mom’s therapists? I thought they had to have weekly meetings but it’s been a long time since I worked inpatient.

The ABN can’t be given right away because no one knows how a patient is going to progress with therapy or how long nursing needs will continue if that’s the qualifying factor. Sometimes a patient will do much better than expected and continue to make progress for weeks. Other times, they may plateau for a variety of reasons, such as medical conditions, willingness to participate, etc. I would often write “maximum benefit achieved from therapy” on the ABN if goals were not met and it was clear they were not going to be. In my experience, therapists tried to give patients every chance to improve.

I cringe when I hear that people are expecting the full hundred days of skilled inpatient services. You have a better chance of receiving those with traditional Medicare but even then, there has to be a skilled need with progress made. Apologies if I’ve misinterpreted your situation and I’m sorry you’re having to deal with this.
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Bgreen7777 Jan 24, 2025
You have written a great response. I just can't understand why I was told to check the box that left Medicare out of the picture otherwise she can't stay there(putting no option to but to be billed for services stated as already havjng met the goals). There was nothing that has been explained that way except the recent email, after I checked a different box(the one to not include Medicare and to not be billed for services and to stop them).
I'm hoping I'm making sense, as all my life nearly everybody doesn't understand how I explain stuff.

There is only quarterly meetings I believe my sister informed of a couple nights ago. But it seems like for some things that isn't enough.
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Bgreen, thank you for the additional information. I’m sorry I don’t quite understand the specifics of your situation. I am curious about what reason they’re giving for non-coverage? They have to provide that.
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Bgreen7777 Jan 23, 2025
It states that her goals are met already, so that begs me to question the whole situation. I didn't get the paperwork till after the therapy was nearly complete, which as I read elsewhere shouldn't have happened.
I am currently talking about info from https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/original-medicare-appeals/advance-beneficiary-notice-abn
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These forms are also utilized in home healthcare and are given to clients for signature when they are about to be discharged(due to no longer qualifying). Basically they state that if you don’t agree with the discharge and dispute it with Medicare and it is denied, you will be responsible for payment of services after the date. An inpatient example would be someone in a skilled nursing facility that no longer qualifies for skilled therapy or nursing services according to the medical professionals. Does this make sense in your situation?
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Bgreen7777 Jan 23, 2025
Yes, I understand what you mean. She was put into a NH with the intention of long term care. I found out last week that there may be issues with the facility staying open. So now wondering if this is just part of several tactics to have her removed, since they're telling me which box to check. But moving her again will be brutal all around.
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"The Advance Beneficiary Notice of Non-coverage (ABN), Form (CMS-R-131) helps Medicare Fee-for-Service (FFS) patients make informed decisions about items and services Medicare usually covers but may not in specific situations. For example, the items or services may not be medically necessary for a patient."

I understand what this means but don't remember signing anything for Mom like this. I guess they can ask you to check the box or she can't stay? We need to know what box you did not check.

This sounds like its to protect Mom and them to. I have seen alot a Medicare statements where Medicare is billed and they don't except the charge. It ends up just being a matter of the facility to recode to get paid. Also, Medicare only pays 80%. Mom will owe the 20%. So if asking if Mom (or POA) that she understands she is responsible for any balances left after Medicare pays what they deem as reasonable, the answer is yes. She either has a suppliment that pays the 20% or she pays the balance.
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Bgreen7777 Jan 22, 2025
She's not Medicaid approved yet, so the limited Medicare coverage is all there is. Supplemental coverage is non-existent, as too expensive for their income levels.

The question is more about they have stated, if I don't check the box making mom 100% liable, she can't stay there. As stated elsewhere, the form also states they can't choose for me/her.
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What is the box that they need you to check in order to allow your Mom to stay there? Is it about who is financially responsible for the facility costs if your Mom doesn't qualify for LTC?

Yes, it is legal for them to reject your Mom as a resident based on ability to pay.

But, more clarifying info from you would be helpful. Need to know what is the agreement connected to that specific box.

Also, in your response to AlvaDeer, do you mean Medicaid, not Medicare?
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Bgreen7777 Jan 22, 2025
Yes, it's about a $300/day charge, the box they want checked is that Medicare won't be pursued and I won't be able to even appeal to them.

The form says they can't choose for me, but yet they've stated that if I don't choose box 2(putting mom fully responsible and Medicare not being billed), then she can't stay there.
That to me is against what the form says they can legally do.
Nope, Medicare is accurate as she's currently only on Medicare. Medicaid has been applied for, and being processed.

Thanks
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Wouldn't know. Can't know the specifics in this case at all. Have no idea what happened here. We are just a bunch of strangers. This is for you to follow up on and I sure wish you the best of luck.
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Bgreen7777 Jan 22, 2025
The form is given out by long term care facilities, nursing homes, and even some hospitals.
It's about a possibility of no coverage from Medicare for services rendered to someone that you are a POA for.
Just thought I might find someone who's experienced recieving one and having to sign it.
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