NOMNC Appeal Georgia: How to Fight a Skilled Nursing Facility Coverage Termination

What a NOMNC Means and Why the Clock Is Already Running

A Notice of Medicare Non-Coverage (NOMNC) is the written document a skilled nursing facility delivers when Medicare-covered services are about to end. It must be delivered at least two calendar days before the last day of coverage.

When you receive a NOMNC, it means the facility's therapy team has determined that your parent no longer meets Medicare's criteria for skilled nursing care — usually because they've concluded the patient has "plateaued" and isn't making measurable progress.

The moment you receive this notice, you're on a strict timeline. You have until noon on the day before Medicare coverage ends to file an expedited appeal. Miss that deadline, and the coverage terminates as scheduled — leaving the resident or another responsible payer exposed to the facility's full private-pay rate.

How to File the Appeal

Call Acentra Health at 1-888-317-0751. This is Georgia's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — the independent organization that reviews Medicare coverage disputes.

When you call, you'll need:

• Your parent's full name and Medicare number
• The name and address of the skilled nursing facility
• The date you received the NOMNC
• The date services are scheduled to end
• Your specific reasons for believing continued skilled care is needed

Acentra will contact the facility, request clinical records, and make an independent determination — typically within 24–72 hours.

Critical protection: if you file within the deadline, your parent generally remains in the facility while Acentra reviews the appeal, and you generally will not be responsible for the continued stay during the review except for applicable coinsurance or deductibles. Confirm the facility's payment and discharge terms.

Building the Case Against "Plateaued"

The word "plateaued" sounds final, but it's a clinical judgment — and clinical judgments can be wrong, incomplete, or based on inadequate documentation.

Medicare's coverage standard for skilled nursing is more nuanced than most families realize. Coverage doesn't require continuous improvement. Medicare covers skilled care when:

• The patient needs services that require the skills of a licensed nurse or therapist (even if progress is slow)
• Skilled maintenance therapy is needed to prevent decline — the patient's condition would deteriorate without continued skilled intervention
• The patient's medical condition is complex enough that only a skilled professional can safely manage the care regimen

"Plateaued" often means the patient stopped hitting specific improvement milestones in a standardized assessment. But if stopping therapy would cause your parent to lose the gains they've made — for example, they can now transfer from bed to wheelchair with one-person assist, but without continued therapy they'd regress to requiring two-person assist — that's a legitimate clinical argument for continued coverage.

What to Document Before the Appeal

Before calling Acentra, gather as much concrete evidence as you can:

Ask the therapy team for objective measurements:

• Walking distance and gait speed (week 1 vs. current)
• Transfer independence scores (bed to wheelchair, wheelchair to toilet)
• Range of motion measurements for affected joints
• Balance assessment scores (Berg Balance Scale, Timed Up and Go)
• Functional independence measure (FIM) scores

Document what you observe daily:

• Activities your parent can do now that they couldn't do at admission
• Activities they still can't do independently that are necessary for safe discharge
• Any episodes of decline — falls, increased confusion, pain that limits participation
• Whether therapy sessions are being cut short due to staffing issues rather than patient limitations

Note the discharge plan gaps:

• Where will your parent go if Medicare coverage ends?
• Is the home environment safe for their current functional level?
• Are home health services in place to continue therapy at home?
• Does your parent have someone who can provide 24-hour supervision if needed?

If the facility is recommending discharge to home but your parent can't safely manage there, that disconnect strengthens your appeal.

What Happens After the Review

If Acentra rules in your favor, Medicare coverage continues and the facility must revise its treatment plan. The facility can issue another NOMNC when it again determines coverage criteria are no longer met — starting the process over.

If Acentra rules against you, coverage ends as of the date in the original NOMNC (or the date of Acentra's decision, whichever is later). From that point, the resident or another responsible payer may face the full private-pay rate — which averages $6,000–$9,000 per month in Georgia.

You can ask Acentra or Medicare about appealing the decision to the next level — a Qualified Independent Contractor (QIC). Coverage does not necessarily continue during that review, so confirm payment and discharge terms before relying on it.

The Private-Pay Transition and Medicaid Planning

When Medicare coverage genuinely ends and your parent still needs nursing facility care, the financial picture changes dramatically. At private-pay rates, even substantial savings can be depleted in months.

If your parent's countable assets are at or near the 2026 Georgia Medicaid limit of $2,000 and their income is below $2,982 per month (or a Qualified Income Trust can be established to bridge the gap), they may qualify for Long-Term Care Medicaid. The facility can allow your parent to remain on a "Medicaid pending" basis while the application is processed — Georgia law prohibits facilities from discharging residents solely for non-payment while a Medicaid application is actively pending if the applicant or representative is cooperating.

Starting the Medicaid application process before Medicare coverage ends gives your family the most options and the least financial exposure.

Get the Full SNF Transition Guide

The Georgia Hospital-to-Home Discharge Guide covers the complete skilled nursing facility journey — from evaluating facilities before admission to filing NOMNC appeals to transitioning to Medicaid when Medicare runs out. It includes the appeal documentation checklist and the QIT setup workflow.

See more Georgia guides →