As of January 1, 2025, updated versions of the Notice of Medicare Non-Coverage (NOMNC, CMS-10123) and Detailed Explanation of Non-Coverage (DENC, CMS-10124) are in effect. These changes, approved by the Office of Management and Budget (OMB), bring new requirements and enhanced clarity for providers and beneficiaries. Medicare Advantage (MA) plans have an extended deadline for…
As of January 1, 2025, updated versions of the Notice of Medicare Non-Coverage (NOMNC, CMS-10123) and Detailed Explanation of Non-Coverage (DENC, CMS-10124) are in effect. These changes, approved by the Office of Management and Budget (OMB), bring new requirements and enhanced clarity for providers and beneficiaries. Medicare Advantage (MA) plans have an extended deadline for certain updates, but most providers need to act immediately.
Key Updates to the Notices
- Enhanced Appeal Rights for Medicare Advantage (MA) Enrollees
- MA beneficiaries now have expanded rights to file late appeals or appeals after the planned termination date with the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
- Revised DENC Requirements
- Health plans must document changes in a beneficiary’s condition for repeat appeals during the same episode of care.
- Special instructions provide clarity on handling these situations to ensure consistency.
Important Deadlines
- NOMNC: Use of the revised notice is mandatory for both Original Medicare and Medicare Advantage as of January 1, 2025.
- DENC: While Original Medicare requires immediate implementation, Medicare Advantage plans have until April 1, 2025, to comply due to operational complexities.
Who Needs to Take Action?
- Providers: Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), Hospices, and Comprehensive Outpatient Rehabilitation Facilities (CORFs) must issue the NOMNC to beneficiaries when Medicare-covered services end.
- When Beneficiaries Appeal: Providers must issue a DENC, explaining the specific reasons for service termination, only if an expedited determination is requested.
Access the Updated Notices
The revised NOMNC and DENC, including Spanish versions, are available for download on the Beneficiary Notice Initiative website. Detailed guidance on the expedited determination processes for Original Medicare and Medicare Advantage is also provided.
Why These Updates Matter
The changes are designed to streamline the appeals process, ensuring beneficiaries understand their rights and options when Medicare services end. For providers, this is an opportunity to align with regulatory updates while enhancing communication and support for patients, fostering transparency, and ensuring a fair and consistent appeals process.
Begin using the updated notices today to maintain compliance, ensuring beneficiaries receive the essential information they need for seamless care transitions.
REFERENCE: www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-ma-nomnc-denc