Home health agencies are required to give people with Original Medicare written notices in certain situations.
“Advance Beneficiary Notice of Noncoverage” (ABN)
When the home health agency believes that Medicare may not pay for some or all of your home health care, the agency should give you an ABN.
Home health agencies are required to give you an ABN in these situations:
- If care is reduced or terminated
- Before you get any items or services that Medicare may not pay for because of any of these reasons:
- They’re not considered medically reasonable and necessary.
- The care is custodial care.
- You aren’t confined to your home.
- You don’t need intermittent skilled nursing care.
“The Home Health Advance Beneficiary Notice” (HHABN) has been discontinued. It was replaced by the HHCCN and the ABN in 2013.
“Home Health Change of Care Notice” (HHCCN)
The HHCCN is a written notice that your home health agency should give you when your home health plan of care is changing because of one of these:
- The home health agency makes a business decision to reduce or stop giving you some or all of your home health services or supplies.
- Your doctor changed your orders, which may reduce or stop giving you certain home health services or supplies that Medicare covers.
The HHCCN lists the services or supplies that will be changed, and it gives you instructions on what you can do if you don’t agree with the change.
The home health agency isn’t required to give you a HHCCN when the “Notice of Medicare Non-coverage” (NOMNC) is issued.
“Notice of Medicare Non-Coverage” (NOMNC)
Your home health agency will give you a NOMNC when all of your Medicare-covered services are ending. This notice will tell you when the services will end and how to appeal if you think the services are ending too soon. The NOMNC tells you how to contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to ask for a fast appeal. If you don’t get this notice, ask for it.
If you decide to ask for a fast appeal, call the BFCC-QIO within the timeframe listed on the notice. After you request a fast appeal, you’ll get a second notice with more information about why your care is ending. The BFCC-QIO may ask you questions about your case. To help your case, ask your doctor for information, which you can submit to the BFCC-QIO.
"Detailed Explanation of Non-Coverage" (DENC)
Your home health agency will give you a DENC when it's informed by the BFCC-QIO that you've requested a BFCC-QIO review of your case. The DENC will explain why your home health agency believes that Medicare will no longer pay for your home health care.