NOMNC Manual Instructions Issued
May 31, 2013 03:19 PM
Transmittal 2711 was recently published by the Centers for Medicare & Medicaid Services (CMS). The transmittal updates Chapter 30, Sections 260 through 261 of the Medicare Claims Processing Manual. The update reflects provisions of the final rule that became effective July 2005 and offers operating guidance for the Expedited Determination Notice (ED) for termination of Medicare covered services via the Notice of Medicare Non-Coverage (NOMNC).
Despite longstanding notice requirements, the manual revision identifies the implementation and effective dates of these instructions as August 26, 2013. Current instructions for the NOMNC are available on the CMS website here.
Section 1869(b)(1)(F) of the Social Security Act grants beneficiaries in Original Medicare the right to an expedited determination process to dispute the end of their Medicare covered care in certain provider settings. Settings include Home Health Agencies (HHA), Comprehensive Outpatient Rehabilitation Services (CORFS), Hospice, and Skilled Nursing Facilities (SNF). This manual update provides expanded guidance for notice requirements and processes.
The manual update starts with more detailed descriptions of exceptions to NOMNC requirements than are available at this time. Exceptions include instances where no Medicare covered services had been provided, reductions in services, moves to higher levels of care, exhaustion of benefits, beneficiary choice and provider business reasons.
Guidance for completing and amending the NOMNC is basically unchanged except for the allowance to include an optional “Additional Information” section and a directive to make the effective date as the last day beneficiaries will receive Medicare coverage for their services.
Questions about the ability to issue NOMNCs electronically have been raised with the increased frequency with the growth in use of electronic health records (EHR). CMS responded to these questions by allowing the electronic issuance of NOMNCs as well as electronic signatures. However, beneficiaries must be given the option to view the notice in paper format rather than on an electronic screen before signing. Additionally, regardless of how viewed and signed, a paper copy of the NOMNC must be given to the beneficiary at the time of the notice delivery. The original signed NOMNC must be retained in the beneficiary’s file. If the NOMNC was delivered electronically, the electronic notice retention is permitted.
Delivery of the NOMNC
The instructions allow for delivery of NOMNCs by a delegated agent. However, all delivery requirements must be met, including the requirement to obtain the beneficiary or representative signature and date. Signatures may be by an assistive device.
The delivery timeframe remains at least two calendar days - not 48 hours. Deliveries are not required outside of normal provider operating hours. Exceptions to the two calendar day delivery timeline apply to HHAs. HHAs must deliver notices no later than the next-to-last visit before coverage ends.
Additionally, where a beneficiary is not longer homebound the NOMNC should be immediately delivered upon knowledge of non-homebound status.
Notices may be given earlier than two days before end of coverage as long as the delivery date is tied to an impending end of coverage. Since that is generally not true is given routinely at the start of service notices may only be given at the start of service in short term cases.
The manual update also includes extensive information about requirements in cases where notices must be delivered to beneficiary representatives.
Appeal to QIO
Finally, the manual addresses procedures related to appeals filed to the Quality Improvement Organization (QIO). These sections reiterate current requirements that providers make available Detailed Explanation of Noncoverage (DENC) and medical records to the beneficiary and the QIO upon notification of an appeal.