Beneficiary Notices Initiative (BNI)
Beneficiary Notices Initiative (BNI)
What's New
11/18/2024: The Office of Management and Budget (OMB) has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). Please note the NOMNC and DENC renewed notices contain updates which are applicable only to Medicare Advantage enrollees (see below). Hospitals must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025.
The updated notices, including Spanish versions, are available on the webpage “FFS & MA NOMNC/DENC”, which is linked in the navigation menu on the left.
The Office of Management and Budget (OMB) has also renewed the Notice of Denial of Medical Coverage (or Payment) (CMS-10003). Medicare health plans must use the current notice until December 31, 2024, and are required to use the new notice beginning January 1, 2025.
The updated notice and form instructions are available on the webpage "MA Denial Notice", which is linked in the navigation menu on the left.
Medicare Advantage Only
The NOMNC has been modified to reflect regulations providing enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date. (See: CMS-4205-F, p. 30827.)
Additionally, DENC instructions have been updated to include a new element for health plans to complete for the DENC:
Special instructions for repeat appeals within the same episode of care:
If the enrollee has previously received a favorable QIO appeal decision during the current episode of care, detail the specific change(s) in the enrollee’s condition since the previous appeal that provide the basis for this decision to terminate services.
08/28/2024: With the help of our contractors, we revised the SNF ABN, Form CMS-10055, and the form instructions. The SNF ABN form and instructions are located in the table below and are available for use immediately, but will be mandatory for use on 10/31/2024.
Beneficiary Notices Initiative
Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Use the navigation links on the left side of this page or in the table below to access the financial liability, appeal and other notices and their instructions.
- FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
- FFS Home Health Change of Care Notice (FFS HHCCN)
- FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNF ABN)
- FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
- FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility (FFS Expedited Determination Notices)
- MA Denial Notices (MA Denial Notices)
- MA Expedited Determination Notices (MA Expedited Determination Notices)
- Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)
- Medicare Outpatient Observation Notice (MOON)
| Notice | Medicare Program | Type of Notice | Provider Type | Purpose | Link to Notice |
|---|---|---|---|---|---|
| Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) | FFS | Financial Liability Notice | Healthcare providers (including independent laboratories, HHAs, and hospices), physicians, practitioners, and suppliers paid under Medicare Part B | Issued in order to transfer financial liability to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case. | ABN, (ZIP)Form CMS-R-131 (ZIP)
|
| Home Health Change of Care Notice (HHCCN, Form CMS-10280) | FFS | Care Changes | HHAs | Issued to beneficiaries receiving home health care benefits for notification of plan of care changes. |
|
| Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, Form CMS-10055) | FFS | Financial Liability Notice | SNF | Issued in order to transfer financial liability to beneficiaries before the SNF provides an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or is custodial in nature. |
|
| Hospital-Issued Notices of Non-coverage (HINNs) | FFS *HINN 10 may be used for MA | Financial Liability Notices | Hospitals | Issued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case. There are currently four different HINNs. | HINNs (ZIP) |
| Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) | FFS & MA | Expedited Determination Notices | HHAs, SNFs, Hospices, and CORFs | Informs beneficiaries of their discharge when their Medicare covered services are ending. |
|
| Detailed Explanation of Non-Coverage (DENC, Form CMS-10124) | FFS & MA | Expedited Determination Notices | HHAs, SNFs, Hospices, and CORFs | Given only if a beneficiary requests an expedited determination. Explains the specific reasons for the end of covered services. |
|
| Important Message from Medicare (IM, Form CMS-10065) | FFS & MA | Hospital Discharge Appeal Notices | Hospitals | Informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. | IM, Form CMS-10065 (ZIP) |
| Detailed Notice of Discharge (DND, Form CMS-10066) | FFS & MA | Hospital Discharge Appeal Notices | Hospital or MA Plan | Given only if a beneficiary requests expedited review of a discharge decision. Explains the specific reasons for the discharge. | DND, Form CMS-10066 (ZIP) |
| Integrated Denial Notice (IDN, Form CMS-10003) | MA | Denial Notices | Medicare Health Plans | Issued upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment. | IDN, Form CMS-10003 Spanish (ZIP)
|
| Medicare Outpatient Observation Notice (MOON) | FFS & MA | Hospital notice of observation services and are not inpatients | Hospital or MA Plan | Issued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH). |
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Medicare Outpatient Observation Notice (MOON)
Information on the MOON can be found using the left navigation menu.
Questions?
Questions regarding any of the Fee For Service BNI notices, the Medicare Advantage notices, and the MOON can be submitted at: https://appeals.lmi.org
Page Last Modified:
11/18/2024 02:08 PM