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Medicare Cut Letter Information


SNF Notice Cheat Sheet

Download SNF Notice Cheat Sheet.pdf

NOMNC Instructions

A Medicare health provider must give an advance, completed copy of the Notice of Medicare Non-Coverage (NOMNC) to enrollees receiving skilled nursing, home health (including psychiatric home health), or comprehensive outpatient rehabilitation facility services, no later than two days before the termination of services. This notice fulfills the requirement at 42 CFR 422.624(b) (1) and (2)In situations where the termination decision is not delegated to a provider, the plan must provide the service termination date to the provider not later than two days before the termination of services for timely delivery to occur.

Download NOMNC Instructions-1.pdf

NOMNC

NOMNC Guidance Issued to MyCare Ohio Plans April 10, 2015. When should providers issue the Notice of Medicare Non -Coverage? Under Section 2.10.5 of the Ohio 3 -way contract, and in accordance with Chapter 9, Section 8 of the MyCare Ohio member handbook, beneficiaries receiving services from home health agencies (HHAs), comprehensive outpatient rehabilitation facilities (CORFs), and skilled nursing facilities (SNFs) must receive a Notice of Medicare Non - Coverage (NOMNC) at least two calendar days before a Medicare - covered service is scheduled to end. Providers are responsible for delivering this notice. More detail about the NOMNC is available at NOMNC -The NOMNC gives a beneficiary access to a fast- track Medicare appeals process designed to prevent inappropriate termination of services or discharge from a facility . The process and notices were implemented as part of a 2003 litigation settlement and are not waived as part of the MyCare Ohio demonstration. Note also that Medicare rules require issuing the NOMNC only when Medicare-covered services are terminating. Reductions in services are not subject to the NOMNC rules. In the context of the MyCare Ohio demonstration, there are circumstances where the NOMNC should be tailored or not be issued. For example: If the “Medicare-covered” portion of a benefit ends , but the “Medicaid-covered” portion of the benefit provides unchanged coverage for the beneficiary, the NOMNC should not be issued. If the end of the “Medicare-covered” portion of the benefit results in a reduction in services for the beneficiary , the plan/provider should issue the NOMNC and specify in the “Additional Information” field in the NOMNC how the beneficiary’s services are changing and that a discharge or service termination is not occurring. If the “Medicare-covered” portion of the benefit is endin g, and the service is not being continued under the Medicaid benefit the NOMNC should be issued. NOTE: If a member is receiving skilled services beyond the usual 100 day benefit period for Medicare (for example they are receiving skilled services under the plan for 105 days), do not issue the NOMNC if the services terminate on day 105. Under Medicare rules, the NOMNC is not issued when a Medicare service is exhausted.

Download NOMNC English 10123 Ohio-1.doc

Part A ABN

Download Part A SNF ABN 10055 Ohio.doc

Part B ABN

Download Part B ABN English R 131.doc

DENC Instructions

Download DENC Instructions.pdf

DENC Form

Download DENC English 10124.doc

NEMB Form- Notice of Exclusion From Medicare Benefits

Download NEMB 20014.doc