New Medicare NOMNC and DENC in Effect as of Jan. 1st
(Jan. 14, 2025) As of Jan. 1st, providers have been required to use a revised Notice of Medicare Non-Coverage (NOMNC / Centers for Medicare and Medicaid Services (CMS)-10123) and Detailed Explanation of Non-Coverage (DENC / CMS-10124) for patients and residents covered by Original Medicare. For patients and residents covered by Medicare Advantage (MA) plans, the revised DENC is not required until April 1, 2025, although the revised NOMNC must be used as of Jan. 1st.
The revised notices were issued in November 2024, but were not effective until 2025. CMS granted an extension of the deadline for the DENC for MA beneficiaries because MA plans required additional time to implement the new form. They are required to do so as soon as practicable, but no later than April 1, 2025.
Home health agencies, skilled nursing facilities, hospices, and comprehensive outpatient rehabilitation facilities are required to provide a NOMNC to beneficiaries when their Medicare-covered service(s) are ending. The NOMNC explains how to request an expedited determination from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) and gives beneficiaries the opportunity to request an expedited determination from a BFCC-QIO. A DENC is provided only if a beneficiary requests an expedited determination. The DENC explains the specific reasons for the end of covered services.
More information is available from CMS here and from LeadingAge National here.
Contact: Karen Lipson, klipson@leadingageny.org