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Beneficiary Notices Initiative (BNI)

What’s New

11/18/2024: The Office of Management and Budget (OMB) has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). Please note the NOMNC and DENC renewed notices contain updates which are applicable only to Medicare Advantage enrollees (see below). Hospitals must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025.

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The updated notices, including Spanish versions, are available on the webpage “FFS & MA NOMNC/DENC”, which is linked in the navigation menu on the left.

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The Office of Management and Budget (OMB) has also renewed the Notice of Denial of Medical Coverage (or Payment) (CMS-10003). Medicare health plans must use the current notice until December 31, 2024, and are required to use the new notice beginning January 1, 2025.

The updated notice and form instructions are available on the webpage “MA Denial Notice”, which is linked in the navigation menu on the left.

Medicare Advantage Only

The NOMNC has been modified to reflect regulations providing enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date. (See: CMS-4205-F, p. 30827.)

Additionally, DENC instructions have been updated to include a new element for health plans to complete for the DENC: Special instructions for repeat appeals within the same episode of care:If the enrollee has previously received a favorable QIO appeal decision during the current episode of care, detail the specific change(s) in the enrollee’s condition since the previous appeal that provide the basis for this decision to terminate services.

08/28/2024: With the help of our contractors, we revised the SNF ABN, Form CMS-10055, and the form instructions. The SNF ABN form and instructions are located in the table below and are available for use immediately, but will be mandatory for use on 10/31/2024.

Beneficiary Notices Initiative

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Use the navigation links on the left side of this page or in the table below to access the financial liability, appeal and other notices and their instructions.

FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
FFS Home Health Change of Care Notice (FFS HHCCN)
FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNF ABN)
FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility (FFS Expedited Determination Notices)
MA Denial Notices (MA Denial Notices)
MA Expedited Determination Notices (MA Expedited Determination Notices)
Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)
Medicare Outpatient Observation Notice (MOON)

NoticeMedicare ProgramType of NoticeProvider TypePurposeLink to NoticeAdvance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131)FFSFinancial Liability NoticeHealthcare providers (including independent laboratories, HHAs, and hospices), physicians, practitioners, and suppliers paid under Medicare Part BIssued in order to transfer financial liability to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case.

ABN, (ZIP)Form CMS-R-131 (ZIP)

ABN Form Instructions (PDF)

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Home Health Change of Care Notice (HHCCN, Form CMS-10280)FFSCare ChangesHHAsIssued to beneficiaries receiving home health care benefits for notification of plan of care changes.

HHCCN, Form CMS-10280 (ZIP)

HHCCN Form Instructions (PDF)

Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, Form CMS-10055)FFSFinancial Liability NoticeSNFIssued in order to transfer financial liability to beneficiaries before the SNF provides an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or is custodial in nature.

SNF ABN, Form CMS-10055 (PDF)

SNF ABN Form Instructions (PDF)

Hospital-Issued Notices of Non-coverage (HINNs)

FFS

*HINN 10 may be used for MA

Financial Liability NoticesHospitalsIssued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case. There are currently four different HINNs.HINNs (ZIP)Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123)FFS & MAExpedited Determination NoticesHHAs, SNFs, Hospices, and CORFsInforms beneficiaries of their discharge when their Medicare covered services are ending.

NOMNC, Form CMS-10123 (ZIP)

NOMNC Form Instructions (PDF)

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Detailed Explanation of Non-Coverage (DENC, Form CMS-10124)FFS & MAExpedited Determination NoticesHHAs, SNFs, Hospices, and CORFsGiven only if a beneficiary requests an expedited determination. Explains the specific reasons for the end of covered services.

DENC, Form CMS-10124 (ZIP)

DENC Form Instructions (PDF)

Important Message from Medicare (IM, Form CMS-10065)FFS & MAHospital Discharge Appeal NoticesHospitalsInforms hospitalized inpatient beneficiaries of their hospital discharge appeal rights.IM, Form CMS-10065 (ZIP)Detailed Notice of Discharge (DND, Form CMS-10066)FFS & MAHospital Discharge Appeal NoticesHospital or MA PlanGiven only if a beneficiary requests expedited review of a discharge decision. Explains the specific reasons for the discharge.DND, Form CMS-10066 (ZIP)Integrated Denial Notice (IDN, Form CMS-10003)MADenial NoticesMedicare Health PlansIssued upon denial, in whole or in part, of an enrollee’s request for coverage and upon discontinuation or reduction of a previously authorized course of treatment.

IDN, Form CMS-10003 (ZIP)

IDN, Form CMS-10003 Spanish (ZIP)

IDN Form Instructions (PDF)

Medicare Outpatient Observation Notice (MOON)FFS & MAHospital notice of observation services and are not inpatientsHospital or MA PlanIssued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).

MOON, Form CMS-10611 (ZIP)

Medicare Outpatient Observation Notice (MOON)

Information on the MOON can be found using the left navigation menu.