The NOMNC: When Rehab, Home Health, or Hospice Is Ending

A NOMNC, or Notice of Medicare Non-Coverage, is the form that tells you and your loved one that services are about to end. A skilled nursing facility (a rehab stay), a home health agency, or a hospice has to give it to you at least two days before the planned discharge. If you disagree with the discharge, you can appeal to Medicare, and the most important thing to know is that appealing on time protects you.

Who gives one

A skilled nursing facility gives a NOMNC before a rehab stay ends. Home health agencies give one before home health ends, and a hospice gives one before a live discharge, when hospice ends because your loved one is no longer considered terminally ill. The process is the same in every case: the same two days of notice, the same deadline, the same kind of appeal.

Why appeal if you disagree?

The biggest mistake families make is not appealing at all. Many worry they will owe money if the appeal is denied, so they decide it is not worth the gamble. That worry is usually misplaced.

Once you appeal by the deadline, the facility or agency cannot bill you for that care while Medicare reviews the decision. If Medicare agrees with the discharge, the decision letter tells you the date you would start paying, and the discharge goes ahead from there. If Medicare disagrees, your loved one keeps their services.

How to appeal

The phone number is printed on the NOMNC itself. It goes to an independent Medicare reviewer, not the facility or the agency, and it changes by location, so use the number on your notice.

1. Have the planned discharge date in front of you, along with the facility's or agency's name and phone number.
2. Call the number on the notice before noon on the day before the discharge date.
3. Say that you do not agree with the planned discharge and you want to appeal the decision.
4. Write down who you spoke with and when.

What happens after you call?

The facility or agency cannot bill you while the reviewer looks at the medical records, and an answer usually comes within a day or two, often by the discharge date. The reviewer either agrees with the discharge, and it goes ahead, or disagrees, and your loved one can stay on services.

What if you miss the deadline?

Call the number anyway. The reviewer still takes a late request, but without the protection above: the facility or agency can bill you for care after the date on the notice while it decides.

A hospital stay uses a different notice

A hospital stay, including an inpatient rehab hospital, uses the Important Message from Medicare instead of a NOMNC. It has its own appeal through the same kind of reviewer, due by the day of discharge.

This article is general information for family caregivers, not legal or medical advice. Follow the instructions on the notice itself.