NOMNC Appeal Timeline Minnesota

The Rehab Facility Just Said Medicare Coverage Is Ending

Your parent is two weeks into a skilled nursing rehab stay after hip surgery. The therapy team says they are making progress, but the facility just handed you a form titled "Notice of Medicare Non-Coverage" — the NOMNC. It says Medicare-covered services will stop in two days.

This is not the end of the conversation. You have a narrow but powerful right to challenge that decision, and the deadline is measured in hours, not weeks.

What the NOMNC Means

The Notice of Medicare Non-Coverage is a federal form (CMS-10123) that skilled nursing facilities must deliver at least two calendar days before Medicare-covered services are scheduled to end. It tells you the specific date coverage will stop and explains your right to request an expedited review.

The form itself is not a clinical determination that your parent no longer needs therapy. It is a billing notice driven by the facility's assessment of what Medicare will continue to pay for. Those are different questions, and the appeal process exists because facilities sometimes get the answer wrong.

The Deadline That Matters Most

You must contact Commence Health — Minnesota's designated BFCC-QIO — by noon on the day before the service termination date listed on the NOMNC. Not by midnight. Not by end of business. Noon.

Call them at 1-888-524-9900.

If the NOMNC says services end on Thursday, you must call Commence Health by noon on Wednesday. Miss that deadline and you lose the automatic billing protection — your parent can still appeal, but the family will be financially responsible for the daily rate while the review is pending.

What Happens When You File on Time

When Commence Health receives your appeal before the deadline:

• The SNF cannot stop Medicare-covered services while the review is pending
• The SNF cannot bill your parent for the continued days during the review
• An independent physician at Commence Health reviews the medical records — not the facility's own staff
• You receive a decision, typically within 24-48 hours

If the QIO determines that your parent still meets the criteria for skilled nursing care, Medicare coverage continues. If the QIO agrees with the facility, coverage ends on the date specified in their decision, and you can pursue a second-level appeal through a Qualified Independent Contractor.

Build a Clinical Case, Not an Emotional One

The QIO physician reviewing the appeal looks at clinical documentation: therapy progress notes, nursing assessments, physician orders, and measurable functional goals. An appeal that says "my parent isn't ready" carries less weight than one that identifies specific, ongoing skilled care needs.

Strong appeal points include:

• Active wound care that requires skilled nursing
• Therapy goals that have not yet been met (documented in the facility's own care plan)
• A new medical complication that developed during the rehab stay
• Inability to safely perform daily activities needed at home (transfers, medication management)

The Financial Stakes Are Real

If you miss the appeal deadline or lose the appeal, the family faces private-pay SNF rates. In Minnesota, that averages $11,869 per month — roughly $395 per day. Even a few extra weeks of coverage through a successful appeal can save thousands of dollars.

The Minnesota Hospital Discharge Navigation System includes the complete NOMNC appeal timeline, a clinical documentation checklist for building your case, and scripts for communicating with the facility's care team during the process. It covers both Original Medicare and Medicare Advantage appeal tracks, which have different internal review steps.

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