Integrity Home Health Minute, 10/3/25

What is the Home Health Notice of Medicare Non-Coverage (NOMNC) Form?

The NOMNC (Form CMS-10123) is a standardized notice that home health agencies (HHAs) must give to Medicare beneficiaries when their covered home health services—such as skilled nursing or therapy—are ending. It's required by federal regulations to provide advance warning of coverage termination.

Purpose

• To inform the patient that Medicare will no longer pay for skilled home health services after a certain date.

• To explain that the home health agency believes skilled care is no longer medically necessary or reasonable under Medicare rules.

• To provide the patient with their right to appeal the decision if they disagree.

• To list the exact date services will end and the phone number for the Medicare Quality Improvement Organization (QIO) that handles appeals.

How to Explain It to a Patient or Family

Deliver the form at least 2 days before services end, in person if possible. Use simple, clear language:

• Set a Calm Tone and Introduce the Purpose: Start by saying, "I have some important information about your Medicare coverage for home health services. This notice explains that your covered visits are ending soon, but you have options to keep getting the care you need if you disagree."

• Cover the Key Facts Simply: Point to the form's sections and explain: "Your Medicare-covered home health services will end on [date, e.g., October 5]. Based on Medicare’s rules, services are ending because your condition has improved/you’ve reached your goals/you no longer need skilled nursing or therapy.”

• Highlight Appeal Rights: "You have the right to ask for a fast review by an independent group called the Quality Improvement Organization (QIO). If you call them by [deadline, 72 hours from today], your services can continue while they decide." Point to the QIO phone number on the form.

• Discuss Next Steps and Support: "If the appeal works in your favor, coverage continues. If not, we can help find other options, like private pay or community resources. Do you have questions, or would you like me to help call the QIO?" Offer to document the conversation.

• Confirm Understanding and Get Signature: Ask, "Does this make sense? Let's go over any part again, if you need." Have them sign the NOMNC form to acknowledge receipt. The patient (or representative) signs to confirm they received the notice—not that they agree with it. If the patient or representative refuses to sign, please document this in your visit note.

  
  

A good approach is to avoid jargon like “coverage termination” and instead use simple terms: “Medicare will stop paying for skilled home health after this date.”