When Medicare-covered home health or hospice services are set to end, patients and families often feel blindsided. A lack of clear communication can lead to confusion, emotional distress, and even a decline in patient well-being. If your agency fails to issue the required Notice of Medicare Non-Coverage (NOMNC) correctly, you could face compliance violations and penalties.
At The Home Health Consultant, we specialize in helping agencies navigate complex Medicare regulations. We’ve seen how improper handling of NOMNCs results in patient dissatisfaction, complaints, and legal risks—all of which can harm your agency’s reputation.
In this article, we’ll explain:
- When the NOMNC is required
- How to correctly issue the NOMNC to stay compliant
- What to do if a patient appeals service termination
- Best practices for proper documentation
By the end, you’ll have a clear roadmap to ensure your agency issues NOMNCs correctly while keeping patients informed and your agency protected.
When Do Home Health & Hospice Agencies Need to Issue the NOMNC?
Agencies must issue a NOMNC whenever Medicare-covered services are ending for a specific reason. The most common reasons include:
- Lack of medical necessity: The patient has met their treatment goals, so services are no longer needed.
- Exhaustion of Medicare coverage limits: The patient has reached the maximum number of covered days.
- Loss of eligibility: The patient no longer meets Medicare’s criteria for home health or hospice.
This requirement applies to both home health and hospice:
- Home Health Agencies: when a patient no longer qualifies for skilled nursing or therapy.
- Hospice Agencies: when a patient is no longer eligible or chooses to revoke hospice care.
Issuing the NOMNC on time allows patients to prepare for their next steps. It also helps prevent unexpected disruptions in care.
What Must Be Included in the NOMNC Form for Home Health & Hospice Agencies
When issuing a Notice of Medicare Non-Coverage (NOMNC), you’ll need to use the official, government-approved form. To ensure it’s completed correctly, make sure to include these key details:
- Patient’s Full Name: Clearly write or type their name as it appears in Medicare records.
- Medicare Patient Number: This helps identify the patient in Medicare’s system.
- Type of Coverage: Indicate whether the patient is receiving care through skilled nursing (SNF), home health, outpatient rehabilitation (CORF), or hospice.
- Effective Date: This is the final day Medicare will cover services, meaning care ends after this date.
Pro Tip: The effective date is the last covered day—not the first uncovered one. Filling this out accurately ensures compliance and keeps patients informed about their care status.
How and When to Deliver the NOMNC for Home Health & Hospice Agencies
The timing of NOMNC delivery is strictly regulated. Medicare requires that agencies provide the NOMNC at least two calendar days before the last covered service. If the patient’s care lasts fewer than two days, the notice must be given on the first day of service.
In addition to timing, how the notice is delivered matters. The NOMNC must be:
- Personally handed to the patient or their legal representative.
- Verbally explained to ensure understanding.
- Signed and dated by the patient or their representative as proof of receipt.
A common mistake agencies make is delivering the NOMNC too early or too late. While early notice might seem helpful, patients—especially those in geriatric populations—may forget or misunderstand when services will end.
Delivering the notice too late can lead to non-compliance and penalties. Sticking to the two-day window ensures patients have time to prepare while keeping the agency compliant.
Pro Tip: To ensure compliance and patient understanding, agencies should provide the NOMNC in the language the patient or their caregiver understands. Medicare offers translations of the NOMNC in multiple languages, and agencies should utilize these versions whenever possible.
If the form is not available in a patient’s preferred language, but their representative or caregiver speaks English and can translate the information, that is acceptable. However, this must be documented in the clinical record. Having easily accessible copies of NOMNCs in different languages can help ensure compliance and improve patient communication.
You’ll find an example of what the first page of the form looks like below.
For more in-depth information about the NOMNC form, check out the official instruction sheet from CMS.
What Happens if a HH or HSP Patient Wants to Appeal Medicare Service Termination?
Patients have the right to appeal a service termination if they believe their care should continue. Appeals are handled by the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
BFCC-QIOs are Medicare-contracted groups that help patients and their families. They appeal discharge decisions and ensure patients receive fair, high-quality care.
Similar to MACs, different BFCC-QIOs cover different areas of the country. In the chart below, you’ll see which BFCC-QIOs cover which states.
Knowing which BFCC-QIO your agency falls under is important. On the bottom of the NOMNC form, your agency must fill out your area’s BFCC-QIO information. For more assistance finding your BFCC-QIO’s contact information use their official BFCC-QIO locator.
Once the patient has decided to appeal with their BFCC-QIO, timing is everything. Patients must follow these steps:
- Call the BFCC-QIO before noon the day after receiving the NOMNC. If they miss this deadline, they may lose their right to appeal.
- The BFCC-QIO will review the patient’s medical records and decide if services should continue. The agency must cooperate by providing all requested documentation.
- Services may continue during the appeal, but the patient may be responsible for payment if the appeal is denied. This can be a financial burden. Agencies should help patients understand the risks before they decide to appeal.
For agencies, handling appeals correctly is crucial. It helps maintain compliance and ensures patients feel supported during the process. Proper documentation and timely communication with both the patient and the QIO can make appeals go more smoothly.
HH & HSP NOMNC Documentation Rules: What Medicare Requires & Common Mistakes
Proper documentation is a key part of NOMNC compliance. Agencies must keep a signed copy of the notice in the patient’s records. This means there must be a signed copy both:
- In the patient’s home folder
AND
- In the office patient’s medical record
They must also document the date, time, and method of delivery. If the patient or representative refuses to sign, the agency should document the refusal and note how the form was delivered.
Staff should also document:
- That the form was verbally explained, what exactly was explained and to whom, by name, and the person receiving the information verbalized understanding.
- If the patient/representative said they plan to appeal.
- Any communication related to the appeal process.
To avoid compliance issues, agencies should establish standard procedures for issuing NOMNCs. Staff must be trained on Medicare’s requirements and know how to explain the form in simple terms. Providing the notice in the patient’s preferred language also improves understanding and accessibility.
Pro Tip: Altering or changing the NOMNC form in any way can result in a disqualification. Additionally, the NOMNC form must not be longer than two pages. This makes it essential to use the form directly from CMS.
How to Keep Your Agency Compliant with NOMNC Regulations
Understanding and correctly issuing the Notice of Medicare Non-Coverage (NOMNC) is crucial for home health and hospice agencies. Without this knowledge, agencies risk penalties, patient dissatisfaction, and legal complications.
If your agency struggles with maintaining Medicare compliance, missing deadlines, or patient confusion over service termination, failing to handle the NOMNC correctly can cause serious setbacks. At The Home Health Consultant, we help agencies stay compliant with Medicare while improving patient satisfaction.
If your agency has questions about NOMNC or other regulatory challenges, contact us today for expert guidance.
If you’re not quite ready to chat with us but want to learn more, you can check out our article on ‘How to Avoid Medicare Payment Reductions’ below.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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