A Notice of Medicare Non-Coverage is a standardized CMS form that tells you your Medicare-covered services from a skilled nursing facility, home health agency, hospice, or comprehensive outpatient rehabilitation facility are about to end and explains how to appeal. The provider must give it to you at least two calendar days before coverage stops.1eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Non-Coverage If you disagree, you have until noon the day after you receive the notice to request a free, expedited review from an independent quality improvement organization. Missing that window is the single most expensive mistake you can make with this form.
What the Notice Says and Who Sends It
Original Medicare uses form CMS-10123. Medicare Advantage plans use a companion form, CMS-10095, that works the same way for plan enrollees.2Centers for Medicare & Medicaid Services. FFS and MA NOMNC/DENC The form identifies you and the provider, states the last day Medicare will pay for your services, and lists the phone number for the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that handles appeals in your area.3Centers for Medicare & Medicaid Services (CMS). Notice Instructions for the Notice of Medicare Non-Coverage
Federal regulations require the notice from four types of providers:1eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Non-Coverage
- Skilled nursing facilities, when a Part A stay is ending or Part B therapy at the facility is wrapping up.
- Home health agencies, when Medicare-covered visits are being stopped entirely.
- Comprehensive outpatient rehabilitation facilities, when a covered outpatient program is ending.
- Hospice providers, when the provider is ending the Medicare hospice benefit.
Hospitals do not use this form. If you are an inpatient being discharged, the hospital gives you a different notice, the Important Message from Medicare (CMS-10065), which has its own separate appeal process.4Centers for Medicare & Medicaid Services. FFS and MA IM/DND
One thing the notice will not tell you is why the provider believes your services should end. The clinical and coverage reasons come later, on a Detailed Explanation of Non-Coverage, and only if you actually file an appeal. The notice is a heads-up and a roadmap, not a justification.
When You Should Expect One, and When You Shouldn’t
The regulation defines “termination” narrowly: a discharge from a residential provider or a complete end to a course of covered treatment. A cut to your services is not a termination. If your home health agency drops you from three visits a week to one and you keep receiving some covered care, you will not get a NOMNC for that change.1eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Non-Coverage
Several other situations sit outside this notice entirely:
- Your Medicare benefit is exhausted, such as reaching the 100-day limit on skilled nursing coverage.
- Medicare admission was denied, so covered services never started.
- The services were never Medicare-covered in the first place.
- You voluntarily revoke your hospice election or transfer to a different hospice.
In Medicare Advantage, when one of these exceptions applies, the plan sends a Notice of Denial of Medical Coverage (CMS-10003) instead.5Centers for Medicare & Medicaid Services (CMS). Form Instructions for the Notice of Medicare Non-Coverage CMS-10095
Delivery Timing
The notice must reach you at least two calendar days before your Medicare-covered services end. If you are expected to receive services for fewer than two days total, the provider gives you the notice when care begins. If your care is not daily, such as home health visits with gaps between them, the provider must deliver the notice no later than the next-to-last visit.1eCFR. 42 CFR 405.1200 – Notifying Beneficiaries of Provider Non-Coverage
Providers can deliver the notice earlier than two days out, but CMS guidance says delivery should be closely tied to the actual end of coverage. Handing you the form on the day services begin, when coverage is expected to run for weeks, is not appropriate unless services will genuinely last fewer than two days.6Centers for Medicare & Medicaid Services (CMS). Form Instructions – Notice of Medicare Provider Non-Coverage CMS-10123
How to Appeal
If you think your services should continue, contact the BFCC-QIO listed on the notice. This is an independent review; the QIO does not work for your provider or your plan.
The deadline is tight. You must contact the QIO by noon of the calendar day after you receive the notice.7eCFR. 42 CFR 405.1202 – Expedited Determination Procedures You can call or submit the request in writing. If the QIO is closed when you try to file, for instance on a weekend, the deadline shifts to noon of the next day the QIO is available.
Once your request is in, the QIO has 72 hours to decide. It notifies you, your physician, and the provider of its determination.7eCFR. 42 CFR 405.1202 – Expedited Determination Procedures If the QIO agrees with you, coverage continues. If it upholds the provider, you can pursue a second level of appeal through a reconsideration by a Qualified Independent Contractor.8Centers for Medicare & Medicaid Services. Reconsideration by a Qualified Independent Contractor
When you file, the QIO notifies your provider, and the provider must then give you a Detailed Explanation of Non-Coverage (form CMS-10124) by close of business the same day. The DENC lays out the specific medical facts and Medicare guidelines the provider is relying on.9Centers for Medicare & Medicaid Services (CMS). Notice Instructions for the Detailed Explanation of Non-Coverage (DENC) This is your best window into the reasoning behind the termination, and it only arrives because you appealed.
What You Owe During and After an Appeal
Whether you owe anything hinges on whether you filed on time. If you submitted your expedited request by the noon deadline, you are not financially responsible for continued services through the coverage end date on the notice. Medicare continues to pay while the QIO reviews your case.10Centers for Medicare & Medicaid Services. Medicare Appeals
If the QIO upholds the termination, your exposure starts only after that coverage end date. You will not owe anything for services received on or before it. Care you choose to receive after coverage ends is on you.10Centers for Medicare & Medicaid Services. Medicare Appeals
Miss the noon deadline and you lose that automatic protection. You could be held responsible for charges after the coverage end date on the notice even while a late appeal is being processed.
If You Never Got a Notice
Providers carry the risk when they fail to deliver a valid notice. If a NOMNC was required and the provider did not give you one, the provider is financially liable for continued services until two days after you receive proper notice, or until the effective date on a corrected notice, whichever comes later.11Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual Chapter 30 – Financial Liability Protections You are relieved of liability for that gap.
CMS can also deny payment to the provider and prohibit the provider from billing you. If the provider knew or should have known the services would not be covered and failed to give proper notice, the provider absorbs the cost.12Centers for Medicare & Medicaid Services (CMS). Medicare Advance Written Notices of Non-Coverage If a bill later shows up for services after your coverage supposedly ended and you never received a notice, you have strong grounds to dispute it.
Don’t Confuse It With the SNF-ABN
Skilled nursing facilities sometimes issue a different form, the Skilled Nursing Facility Advance Beneficiary Notice (SNF-ABN, form CMS-10055). The appeal rights are different, so it matters which form you have.
The NOMNC is for ending services Medicare had been covering. The SNF-ABN is for telling you that specific items or services are expected to be denied by Medicare and that you may be responsible for paying. The typical case: you have used all 100 days of your Part A skilled nursing benefit but want to stay. Because the benefit is exhausted rather than terminated, you get an SNF-ABN, not a NOMNC. The same applies if you never had a qualifying hospital stay and were never eligible for Part A skilled nursing coverage to begin with.