Notice of Medicare Non-Coverage: What It Means and How to Appeal

Your parent is in a skilled nursing facility or receiving home health care, and someone just handed you a form titled "Notice of Medicare Non-Coverage." The subtext is clear: Medicare is about to stop paying.

This is Form CMS-10123, and it's one of the most time-sensitive documents in the entire Medicare system. Miss the appeal deadline and your family absorbs the full cost of continued care — which averages over $10,000 per month for a skilled nursing facility.

What the NOMNC Actually Says

The Notice of Medicare Non-Coverage is a formal notification that a skilled care provider — a skilled nursing facility (SNF), home health agency, or hospice — has determined that Medicare-covered services will end on a specific date. It doesn't mean your parent is being kicked out. It means Medicare will no longer pay for the skilled component of their care after that date.

The provider must deliver this notice at least two calendar days before the last covered day of services. For home health, it must arrive during the second-to-last care visit.

The form lists:

• The date Medicare-covered services will end
• The reason the provider believes skilled care is no longer medically necessary
• Instructions for requesting an expedited review
• Contact information for the Quality Improvement Organization (QIO) in your region

Your Appeal Window Is Extremely Tight

If you disagree with the termination — because your parent still needs daily skilled nursing, physical therapy, or other Medicare-covered services — you must file an expedited appeal by noon on the day before coverage is scheduled to end.

Read that again: noon, the day before. Not the day of. Not within 48 hours. Noon, the day before.

For Medicare beneficiaries in Idaho (and Alaska, Oregon, and Washington), appeals go to Acentra Health, the designated Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Region 10:

• Phone: 888-305-6759
• Fax: 844-878-7921
• TTY: 711

Once you file, the provider must issue a Detailed Explanation of Non-Coverage (DENC, Form CMS-10124) explaining the clinical reasoning behind the termination. Acentra's independent physician panel then reviews the case and issues a decision within two days of the scheduled care termination date.

What Happens If You Win the Appeal

If Acentra sides with your family, Medicare coverage continues. The provider cannot bill your parent for the days of care that were in dispute.

If Acentra upholds the termination, you can still request a reconsideration through the next level of Medicare appeals — but at that point, Medicare coverage has ended and the financial clock is running.

What Happens If You Miss the Deadline

If you don't file by noon the day before termination, Medicare coverage ends as scheduled. Your parent can continue receiving care at the facility, but the family pays the full private-pay rate. At Idaho SNF rates, that's roughly $335 per day.

You can still file a late appeal, but it won't pause the billing. The financial exposure between the termination date and any later favorable decision falls entirely on the family.

When You're Most Likely to Receive a NOMNC

The most common scenario: your parent was admitted to a skilled nursing facility after a qualifying three-day hospital stay, received Medicare-covered rehabilitation (physical therapy, occupational therapy, speech therapy), and the therapy team has determined that your parent has "plateaued" — meaning they're no longer making measurable functional progress.

Medicare covers up to 100 days per benefit period in a SNF, but the coverage isn't automatic for all 100 days. Days 1–20 are fully covered. Days 21–100 require a daily coinsurance of $204.00 (2026 rate). And the facility's clinical team can terminate skilled coverage at any point if they determine the care is no longer skilled in nature.

The NOMNC often arrives well before day 100 — sometimes as early as day 14 or 21 — when the rehabilitation team concludes that your parent's condition is stable enough to transition to a lower level of care.

How This Connects to the Bigger Discharge Picture

The NOMNC is just one document in a chain of Medicare notices that families encounter during hospital-to-home transitions. Before the NOMNC, your parent should have received the Important Message from Medicare (Form CMS-10065) at hospital admission, and possibly a Detailed Notice of Discharge (Form CMS-10066) if you appealed the original hospital discharge.

Each form has its own deadline and appeal pathway. Missing any one of them creates a gap in coverage that's difficult to recover from.

The Hospital-to-Home Idaho toolkit maps the complete timeline from hospital admission through SNF termination, with appeal scripts for each stage — including the exact language to use when calling Acentra Health to file an expedited NOMNC appeal. When the clock is measured in hours, having the script ready matters more than having the knowledge.

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