A written notice that skilled nursing, home health or hospice coverage is ending gives a Medicare patient only a short window to ask for an independent review. Medicare.gov says the request must come no later than noon the day before the termination date printed on the notice. A notice listing a Friday end date means noon Thursday, and care after the printed date can become the patient’s own bill.
The rule covers care from a skilled nursing facility, a home health agency, a comprehensive outpatient rehabilitation facility and a hospice. It applies when the provider decides covered care should stop and the patient disagrees. Members of Medicare Advantage plans can ask their plan for an appeal too, but Medicare.gov says different rules apply to them.
The notice that starts the clock
The paper at the center is the Notice of Medicare Non-Coverage, called the NOMNC. Medicare.gov says the provider should hand it over at least 2 days before covered services end. Patients who get no notice are told to ask the provider for one.
The federal rule behind the notice, 42 CFR 405.1200, requires it no later than 2 days before the proposed end of services. It must state the date coverage ends and the date the patient’s financial liability for continued services begins. The patient or a representative signs and dates it to confirm receipt, and if the patient refuses, the provider can note the refusal and that date counts as the receipt date.
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For anyone holding a NOMNC, the question is concrete: what termination date is printed on it, and has noon the day before already passed? A nursing facility patient whose notice says coverage ends Friday must have the request in by noon Thursday. Families who hear about the notice secondhand are the ones most likely to run out of time, which makes the printed date the first thing to find.
Who decides the appeal
The reviewer is a Beneficiary and Family Centered Care Quality Improvement Organization, known as a BFCC-QIO. Medicare.gov describes it as an independent reviewer that decides whether covered services should continue, run by Commence or Acentra depending on the state. It asks the patient why coverage should continue and looks at the medical records and the provider’s information.
The regulation sets the pace once the request is in. Under 42 CFR 405.1202, the review organization must decide no later than 72 hours after receiving the request. The provider must send the patient a detailed notice by close of business on the day the review organization notifies it, and Medicare.gov calls that paper the Detailed Explanation of Non-Coverage.
Coverage continues until the date and time on the termination notice unless the reviewer reverses the decision. While the review is pending, the provider may not bill the patient for the disputed services until the process is complete. The notice itself also tells the patient about the right to submit evidence that services must continue.
What the bill looks like afterward
If the review organization sides with the provider, Medicare.gov says the patient is not responsible for services before the coverage end date on the NOMNC. Services after that date may become the patient’s responsibility. That is where the money risk sits: care past the printed date, billed to the patient instead of Medicare.
If the reviewer decides services are ending too soon, Medicare.gov says Medicare may keep covering skilled nursing, home health, outpatient rehabilitation or hospice care, except for applicable coinsurance or deductibles. Those cost-sharing amounts do not disappear, so a patient who wins the appeal still owes them.
The provider carries risk as well. The regulation puts liability on the provider when the notice was not validly delivered: it must cover continued services until 2 days after valid notice is received or until the termination date on the notice, whichever is later. A notice handed over late, unsigned or incomplete changes the money picture, so patients and families benefit from writing down when and how theirs arrived.
When the noon deadline passes
A late request is not shut out entirely. The regulation says the review organization still accepts it and decides it as soon as possible, but the 72-hour timeframe and the protection against being billed during the review no longer apply. Medicare.gov adds that a patient can ask the plan for a fast reconsideration, though services are covered only if a decision is issued in the patient’s favor.
That difference is why the cutoff matters more than the review itself. A timely request keeps the provider from billing during the review, while a late one leaves the patient paying for any day Medicare later declines to cover. For a nursing facility stay, every extra day is a day of facility charges that no longer rides on Medicare.
The deadline also runs shorter than the notice period suggests. A notice that arrives 2 days before the end date leaves a day and a morning to act, because the cutoff falls at noon on the day before the termination date. Patients who learn of the date late in the day should treat the next morning as the deadline and contact the review organization named on the notice without waiting for the facility to explain the process.
Holding a notice that says coverage is ending?
The cost of this mistake is a care bill that lands on the patient after the date printed on the notice. The review organization decides the appeal, but the paperwork around it, the dates, the copies and the follow-up letters, falls to the patient or a family member.
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
