What Do the New SNF, HHA, and CORF Notification Requirements Mean for Providers?
Although the regulations and accompanying CMS instructions do not require action by any of the four responsible parties until two days before the planned termination of covered services, we want to emphasize that it’s generally in everyone’s best interest for an MA organization and its providers to work together to deliver the advance termination notice to enrollees as soon as the provider knows when the MA organization will terminate coverage. Doing so will allow the patient more time to determine if they wish to appeal and may permit more time for providers and MA organizations to furnish any needed records. In some cases, we recognize that permitting flexibility in the timing of notice delivery may result in an early, and possibly premature, enrollee request for a QIO review. In these situations, the QIO will immediately notify the MA organization of the appeal request, but all parties will need to exercise judgment in determining when it makes sense for the MA organization and/or p
Notice of Medicare Non-Coverage (NOMNC) The NOMNC (formerly referred to as the Important Medicare Message of Non-Coverage ) is a short, straightforward notice that simply informs the patient of the date that coverage of services is going to end and describes what should be done if the patient wishes to appeal the decision or needs more information. CMS is developing a single, standardized NOMNC that is designed to make notice delivery as simple and burden-free as possible for the provider. The NOMNC essentially includes only two variable fields (i.e., patient name and last day of coverage) that the provider will have to fill in. When to Deliver the NOMNC Based on the M+C organization’s determination of when services should end, the provider is responsible for delivering the NOMNC no later than two days before the end of coverage. If services are expected to be fewer than two days, the NOMNC should be delivered upon admission. If there is more than a 2-day span between services (e.g., i
Related Questions
- To meet the requirements of clause 4.6.6 that contractors shall be under the supervision of a nominated person – does that mean they have to be accompanied at all times on site?
- What Do the New SNF, HHA, and CORF Notification Requirements Mean for Providers?
- What does service mean and what are the service requirements ?
