NOMNC Appeal Process: How to Fight When Medicare Coverage Is Ending

The skilled nursing facility hands you a form. It says your parent's Medicare-covered rehabilitation will end in two days. Your parent still cannot walk to the bathroom unassisted, still needs daily physical therapy, still cannot safely return home — but the coverage clock is ticking.

This form is the Notice of Medicare Non-Coverage (NOMNC), and receiving it does not mean you are powerless. You have the right to an immediate, independent review that can extend coverage while the appeal is decided.

What the NOMNC Is and When You Get It

A NOMNC is a standardized Medicare form that skilled nursing facilities, home health agencies, and hospice providers must deliver at least two calendar days before they plan to end Medicare-covered services. It tells you:

• The date your Medicare coverage will end
• That you have the right to request a fast-track (expedited) review
• The phone number for your regional Quality Improvement Organization (QIO)
• That you will not be charged for services received during the appeal review period

The facility is required to give you this notice even if they believe the decision is clinically clear-cut. Missing this notice is a violation of your parent's Medicare rights.

The Fast-Track Appeal: Step by Step

You must act quickly. The timeline is tight by design — but the process protects you if you follow it.

Step 1: Call the QIO before the coverage end date

For Arkansas and the surrounding Region 6 states, the designated Beneficiary and Family Centered Care QIO is Acentra Health. Call them at 1-888-315-0636 before noon on the day Medicare coverage is scheduled to end.

Tell them: "I am requesting a fast-track review of a Notice of Medicare Non-Coverage for [parent's name]."

Step 2: The financial hold kicks in immediately

Once you file the appeal, your parent cannot be charged for continued services while the QIO reviews the case. The facility must continue providing care at Medicare's expense during the review period. This financial protection is automatic — you do not need to negotiate it.

Step 3: The QIO reviews the medical record

Acentra Health's clinical staff — including licensed physicians — will request and review your parent's medical records from the facility. They assess whether the patient still meets Medicare's definition of needing skilled care: services that require the judgment of a licensed nurse or therapist and that are medically necessary for recovery.

Step 4: You get a decision

The QIO must issue a decision by the end of the day after receiving all necessary records from the facility. In practice, this means you typically hear back within 24–72 hours.

• If the QIO rules in your favor: Medicare coverage continues. The facility must develop a revised care plan explaining when and why services will eventually end.
• If the QIO rules against you: Coverage ends at the time specified in the QIO's written notice. You become financially responsible from that point forward, but you have the right to further appeal through the Medicare Redetermination process.

Building a Stronger Appeal

The QIO reviews clinical documentation — not your emotional argument. To strengthen the case:

Document ongoing skilled needs. Keep a log of specific skilled services your parent receives daily: wound care measurements, therapy milestones not yet achieved, medication adjustments requiring nursing judgment, vital sign monitoring protocols.

Ask the attending physician for a supporting statement. If your parent's doctor believes ongoing skilled care is medically necessary, request a written statement. Physicians can submit supplemental documentation to the QIO during the review.

Note any recent declines or setbacks. A fall, a new infection, medication side effects, or a therapy regression all support continued skilled-level need.

Challenge "plateau" language. Facilities sometimes argue that a patient has "plateaued" — stopped improving. Medicare rules do not require continuous improvement. Skilled care is covered when it is needed to maintain function or prevent decline, not only when measurable gains are being made.

What Happens After a Lost Appeal

If the QIO sides with the facility, you still have options:

1. Pay privately for continued SNF care while pursuing further appeals
2. Request a Medicare Redetermination within 120 days of the service denial — this is a fresh, independent review by a different entity
3. Begin Medicaid planning if your parent needs long-term care beyond what Medicare covers

In Arkansas, the transition from Medicare-covered SNF rehab to Medicaid-funded long-term care involves meeting strict financial thresholds — including the $2,982 monthly income cap — and potentially establishing a Qualified Income Trust (Miller Trust). This planning should start before Medicare days run out, not after.

Common Mistakes That Kill Appeals

• Waiting until after the coverage end date to call the QIO. The financial protection only applies if you file before coverage terminates. Once you miss the deadline, you owe for every day past the NOMNC date.
• Accepting the NOMNC without reading it. Some families assume the form is just an informational notice. It is a countdown clock with a hard deadline.
• Arguing with facility staff instead of calling the QIO. The facility made the clinical decision. Only the QIO can override it. Do not waste your limited time trying to convince the nursing director to reverse course.

The Hospital-to-Home in Arkansas guide includes pre-written call scripts for QIO appeals, a NOMNC response checklist, and the complete timeline for escalating a denied claim through Medicare's multi-level appeal system.

The Key Point

A NOMNC is not a final decision. It is a notice with a built-in appeal mechanism designed to protect patients from premature service termination. The appeal is free, the financial hold is automatic, and the QIO review is independent of the facility that made the original coverage determination. Use it.

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