Late last year, CMA was contacted to assist a beneficiary who was being billed over $10,000 from a Medicare-certified Skilled Nursing Facility (SNF). The family learned that the facility had not first submitted the claim to Medicare – for approval or denial. This meant that the beneficiary was being billed directly, and had no appeal rights. On their own, the family requested a “demand bill,” which required the facility to submit the claim to Medicare. Despite this and several more requests, the facility failed to submit the claim to Medicare. After much frustration, the family contacted CMA.
An attorney at CMA submitted another formal demand bill, as well as provided guidance and education to the facility’s billing department. After nearly nine months of regular contact, the bill was ultimately written off by the facility because Medicare – after finally having the opportunity to review the claim – determined the facility was liable for the charges because it had not given the beneficiary proper notice of the noncovered services through a valid SNF ABN (Skilled Nursing Facility Advanced Beneficiary Notice). Undoubtedly, this family would have given up and paid the facility had they not reached out to CMA.
Takeaway: If you or someone you know receives a bill for SNF services directly (without first going through the Medicare review process), assert your rights through a “demand bill” and stay persistent. Keep in mind, however, that Medicare must review the claim within one year of the date of service.
- For more information, visit CMA’s Self-Help Packet for Skilled Nursing Facility Appeals and the Medicare Claims Processing Manual Chapter 30.
November 13, 2025 – C. Huberty