Notice of Medicare Non-Coverage Appeal — How to Fight Care Termination

Your parent is recovering in a skilled nursing facility or receiving home health services, and the provider just handed you a Notice of Medicare Non-Coverage (NOMNC). It says Medicare will stop paying in two days. Your parent is not ready. And nobody explained how to fight it.

The NOMNC is not the end of the conversation. Federal law gives you the right to appeal — but the deadlines are brutally tight. Miss them by a few hours and your family absorbs the full cost of continued care. Here is exactly what to do.

What the NOMNC Means

The Notice of Medicare Non-Coverage (CMS-10123) is a standardized federal form that skilled nursing facilities, home health agencies, and comprehensive outpatient rehabilitation facilities must deliver when they plan to stop Medicare-covered services. The provider must deliver the NOMNC at least two calendar days before the planned termination date.

The NOMNC does not mean your parent's care is ending — it means Medicare's payment for that care is ending. If your parent still needs services, the family becomes responsible for the private-pay cost unless you successfully appeal.

Common scenarios that trigger a NOMNC: the SNF determines your parent has plateaued in rehabilitation and no longer requires daily skilled services, the home health agency decides your parent no longer meets homebound status or skilled care criteria, or the provider believes your parent has reached the goals in the plan of care.

The Appeal Deadline You Cannot Miss

To appeal a NOMNC in Kansas, you must contact Commence Health — the Region 7 Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — by noon on the calendar day before the coverage termination date.

Commence Health: 1-888-755-5580

If the NOMNC says coverage ends on Wednesday, your appeal must be filed by noon on Tuesday. Not midnight. Not end of business. Noon.

You can file by phone or through the online submission form on the Commence Health website. The online form is legally timestamped upon submission, which protects you if there is any dispute about when you filed.

A critical distinction for Kansas families: Commence Health (formerly Livanta) handles all Medicare QIO appeals for Region 7 (Iowa, Kansas, Missouri, Nebraska). Acentra Health, which you may encounter during the CARE pre-admission screening process, handles PASRR behavioral health evaluations — not Medicare appeals. Filing with the wrong organization wastes irreplaceable hours.

What Happens After You File

Once your appeal is received by Commence Health before the noon deadline, several protections activate automatically:

The provider must deliver a Detailed Explanation of Non-Coverage by the end of the day you filed. This document must explain the specific clinical reasons why the provider believes your parent no longer needs Medicare-covered services and cite the applicable Medicare coverage rules.

Commence Health conducts an independent review. Their medical staff reviews the patient's records, consults with the treating physicians, and considers input from the patient or family representative. The QIO must issue its decision by the close of business on the day coverage was originally scheduled to end.

Medicare continues paying through the scheduled termination date regardless of the appeal outcome. If you filed on time, your parent is not responsible for charges during the review period.

If the Appeal Is Denied

If Commence Health upholds the provider's decision, you have one more shot. You can escalate the dispute to a Qualified Independent Contractor (QIC) by noon on the day following the QIO's decision.

The QIC provides a completely independent review — separate from both the provider and the QIO. If the QIC also denies the appeal, further escalation options exist through the Medicare appeals hierarchy (Administrative Law Judge, Medicare Appeals Council, federal court), though these take months and are rarely practical for an immediate care situation.

The SNF-Specific Timeline

For families dealing with a NOMNC in a skilled nursing facility, the context matters. Medicare Part A covers SNF rehabilitation for up to 100 days per benefit period: the first 20 days at 100%, and days 21 through 100 with a daily co-insurance of $204.50 (2026 rate). The NOMNC often arrives around the point where the SNF's therapy team determines the patient has stopped making measurable progress toward skilled rehabilitation goals.

If the appeal fails and Medicare coverage ends, your family faces three immediate options: private-pay the SNF daily rate (typically $250-$350 per day in Kansas for semi-private), apply for KanCare Medicaid if your parent's assets are near the $2,000 individual limit, or transition to home-based care under the Frail Elderly waiver if your parent can safely live at home with support.

Parallel Protection — The Hospital Discharge Appeal

If your parent is still in the hospital and facing a premature discharge (rather than a NOMNC from a post-acute provider), a different appeal process applies. The hospital must deliver the "Important Message from Medicare" form, and you can file an expedited discharge appeal with Commence Health at the same number — 1-888-755-5580 — before midnight on the scheduled discharge day. Filing this appeal halts the discharge entirely while the QIO reviews the case.

The hospital cannot charge your parent for continuing care during the review period, and the hospital must provide a Detailed Notice of Discharge (DND) explaining the clinical rationale for release.

Protect Yourself Before the NOMNC Arrives

The best defense against a NOMNC is documentation. Keep a log of your parent's daily progress, setbacks, and ongoing skilled care needs. Note every therapy session, every medication change, every clinical event. If the SNF's therapy team reports that your parent is "plateauing," ask for the specific functional measurements they are using and request that the physician re-evaluate.

When the NOMNC does arrive, that daily log becomes evidence you can present to Commence Health during the appeal, showing that your parent continues to need and benefit from skilled services.

The Hospital-to-Home Kansas Guide includes pre-written QIO appeal scripts, a daily progress tracking worksheet, and a complete timeline of every Medicare deadline your family needs to hit during a Kansas hospital or SNF transition.

See more Kansas guides →