Notice of Medicare Provider Non-Coverage
Your Medicare rights don’t end when your care does.
If you get a Notice of Medicare Provider Non-Coverage and would like AFMC to review your case, call 1-888-354-9100.
You deserve to get the best health care possible, and Medicare wants to make sure you get that care. That’s why certain kinds of health care providers must give you written notice before your care ends, if Medicare is paying for it.
For years, hospitals have been required to give you a written “Notice of Non-Coverage” if you disagree with their decision to send you home. On July 1, 2005, other types of health care providers also began issuing a Notice of Non-Coverage before they stop care, whether or not the patient disagrees.
You should get this notice if you’re getting care from any of the following, and that care is going to stop:
- Hospice
- Home health agency
- Skilled nursing facility or hospital "swingbed” (for people who are not sick enough for the hospital but still need full-time nursing care)
- Comprehensive outpatient rehabilitation facility (a clinic for patients who no longer need full-time care but still need special treatment)
It’s part of Medicare’s effort to give you information you need as quickly as possible. Once you get a written notice, you can request a new fast-track review process if you think you still need care and that Medicare should pay for it.
If you are in a Medicare Advantage plan, click here.
Frequently Asked Questions
What is a Notice of Medicare Provider Non-Coverage?
What if I'm a member of a Medicare Advantage plan?
What if I feel my care should not end on the date given?
What if I call after hours or on a weekend?
What if I miss the deadline for an immediate review?
What happens after I call AFMC?
What is a Notice of Medicare Provider Non-Coverage?
This is a written notice that should be given to you, the patient, at least two days before your services are to end. For instance, if you have been receiving care from a home health agency, you should get the notice at least two days before your last visit or by the next to last visit. If a patient is not able to read, understand or sign the notice, it will go to the patient’s legal representative. The notice should include:
- The date that Medicare coverage of your service will end
- The date you will have to start paying if you keep getting the service
- A description of how you can appeal the decision
- A description of your right to detailed information about your care
- Other information as required by the Centers for Medicare & Medicaid Services
Can I refuse to sign?
No one can force you to sign a Notice of Non-Coverage, but if you don’t sign, the notice is still valid. The health care provider will make a note on the notice that you refused to sign, record the date and witnesses, and place it in your file.
What if I feel my care should not end on the date given?
Call the Arkansas Foundation for Medical Care (AFMC) at 1-888-354-9100 to request a review. You should do this as soon as possible, but no later than noon of the day before the notice says your care will end. AFMC will review your records and let you know its decision within 72 hours.
Important
If you get a notice of non-coverage from a home health agency OR a comprehensive outpatient rehabilitation facility (CORF):
BEFORE you can request and receive a review by AFMC, you must get a note from a doctor, written and signed by the doctor, that says: “Failure to continue the provision of the service(s) may put the beneficiary’s health at significant risk.” This statement should be faxed to AFMC at 479-649-0004 by either you or your physician.
What if I call after hours or on a weekend?
As Arkansas’ Medicare Quality Improvement Organization, AFMC must take requests for reviews seven days a week, including holidays. If you call on a weekend or holiday, you’ll hear a recording asking you to leave your name and telephone number. Please speak clearly, and an AFMC representative will call you back as soon as possible. If you call after 4:30 p.m. on weekends or holidays, your call will be returned the following morning.
What if I miss the deadline for an immediate review?
If you call later than noon of the day before your care is due to end, you may still be able to get a review, but it won’t happen as quickly. If you plan to keep receiving the care, AFMC will decide your case within seven days. If you stop getting the care, AFMC will have 30 days to decide.
What happens after I call AFMC?
An AFMC representative will ask you why you feel your services should continue and will document any information you provide. Please be available to answer questions or provide information. AFMC will also ask your health care provider for your medical records and any other information needed. You do not have to prepare anything in writing, but you have the right to do so.
As soon as you request a review, AFMC will tell your health care provider. You should then receive a “Detailed Notice” from the provider, explaining why the provider feels your coverage for services should not continue. You will receive this detailed notice only after you request an appeal.
If AFMC agrees that the health care services should no longer be covered by Medicare after the date stated in the Notice of Non-Coverage, Medicare will not pay for these services after that date. You can ask for a second review from MAXIMUS, the Medicare Qualified Independent Contractor, by calling 1-866-336-7895. MAXIMUS must receive your request by noon of the day after AFMC gives you its decision. If not, MAXIMUS may take longer to review your case.
If AFMC or MAXIMUS decides that your care should continue and Medicare should pay, you will not have to pay anything extra. But if both reviews show that your care is no longer needed, you will have to pay for any services received after the date stated on the Notice of Non-Coverage.
If you belong to a Medicare Advantage health plan and you disagree with a notice to terminate services, click here.