How to Appeal a NOMNC in Nebraska: Fighting a Medicare Coverage Termination

What a NOMNC Means for Your Parent

A Notice of Medicare Non-Coverage (NOMNC) is the facility's formal statement that Medicare will stop paying for your parent's skilled nursing, rehab, or home health services on a specific date. It is not a suggestion or a preliminary estimate — it's the start of a countdown.

For Nebraska families, the appeal process runs through Commence Health, the BFCC-QIO for Region 7. If you disagree with the termination, you have a narrow window to act.

The Timeline You're Working With

The facility must deliver the NOMNC at least two calendar days before the proposed coverage end date. The form itself states the last covered day and explains your appeal rights.

To file an expedited appeal, you must contact Commence Health no later than noon the day before the termination date listed on the NOMNC.

If you miss that deadline, you can still ask the BFCC-QIO to review the case, but different rules and time frames apply, and you might be responsible for costs after the original termination date.

How to File the Appeal

Contact Commence Health:

• Phone: 1-888-755-5580
• Fax: 855-694-2929
• Online: Commence Health e-Appeal system

You'll need your parent's Medicare Beneficiary Identifier (MBI) and the name of the facility issuing the NOMNC. Phone is the fastest option — you can file the appeal in a single call.

What Happens After You File

Once your appeal is received, two things happen immediately:

1. Coverage continues through midnight of the day Commence Health issues its determination. Your parent stays in the facility with Medicare paying.
2. The facility must submit clinical documentation supporting the coverage termination to Commence Health, typically within 24 hours.

Commence Health's physician reviewers evaluate whether continued skilled care is medically necessary. The decision usually arrives within one to two business days.

Building Your Case

The appeal succeeds or fails on clinical documentation. Before or immediately after filing, prepare a concise written statement addressing why skilled care should continue. Focus on:

Functional deficits that still require skilled intervention: Is your parent still unable to transfer safely? Do they need skilled nursing for wound care, medication management, or catheter care? Can they perform ADLs independently?

The Jimmo standard: Medicare cannot deny coverage solely because a patient isn't improving. If skilled care is necessary to maintain current function or prevent deterioration, that qualifies. A patient recovering from a stroke who needs continued skilled therapy to avoid losing the mobility gains they've made has a valid clinical basis for continued coverage.

Therapy intensity and progress: Reference the facility's own therapy progress notes. If the notes show ongoing skilled interventions and measurable goals that haven't been fully met, that supports your case.

What happens without continued care: If stopping skilled services would result in a predictable clinical decline — increased fall risk, medication mismanagement, wound deterioration — state that explicitly.

If the Appeal Is Denied

A denied expedited appeal isn't the end. The Medicare appeals process has five levels:

1. Expedited review (QIO — Commence Health) — this is what you just completed
2. QIC reconsideration (Maximus Federal Services) — an independent review of Commence Health's decision; must be requested within 180 days
3. Administrative Law Judge hearing — for amounts exceeding $200 (2026 threshold)
4. Medicare Appeals Council review
5. Federal district court review

Most families resolve their dispute at levels one or two. The QIC reconsideration through Maximus is worth pursuing if you believe Commence Health's initial review missed relevant clinical information. You can submit additional documentation that wasn't available during the expedited review.

The Financial Stakes

If your parent's Medicare rehab coverage ends and they still need skilled care, the private-pay rate at Nebraska nursing facilities averages around $8,000 per month. Even a successful two-day appeal extension can save thousands by keeping Medicare coverage active while you arrange the next step — whether that's a transition to Medicaid-funded long-term care, a return home with waiver services, or a discharge plan.

The Complete Process in One Place

The NOMNC appeal is one stage in a sequence that includes hospital discharge rights, SNF coverage rules, and long-term Medicaid planning. The Nebraska Hospital Discharge Guide covers the full transition with Nebraska-specific forms, financial thresholds, and step-by-step instructions for each phase.

See more Nebraska guides →