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 must give you an ABN.
Home health agencies are required to give you an ABN 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 only nonskilled, personal care, like help with bathing or dressing.
- You aren’t homebound.
- You don’t need skilled care on an intermittent basis.
When you get an ABN because Medicare isn’t expected to pay for a medical service or supply, the notice should:
- Describe the service and/or supply
- Explain why Medicare probably won’t pay
The ABN gives clear directions for getting an official decision from Medicare about payment for home health services and supplies and for filing an appeal if Medicare won’t pay.
“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 home health agency must also give you an ABN or a HHCCN when they reduce or stop providing home health services or supplies 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 at least 2 days before all covered services end. This written notice will tell you when your covered 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.