Medicare Coverage Notices Get a Revamp
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Medicare Coverage Notices Get a Revamp

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May 15, 2012

In an effort to help people with Medicare better understand their benefits and coverage under Medicare, the Centers for Medicare & Medicaid Services (CMS) recently redesigned three types of Medicare coverage notices.

1. Medicare Summary Notice (MSN): This notice provides claims information to your clients in Original Medicare about services provided under Medicare Part A and Part B.  It includes a summary of Medicare’s official decision of coverage and payment. If your clients disagree with Medicare’s decision, they can appeal by requesting a redetermination. Instructions on how to appeal are included in the notice. Your clients in Original Medicare get this notice every 3 months, or quarterly. 

View a side-by-side comparison of the previous and the revised MSN.

What is different about the revised MSN?

The revised MSN now uses clearer language, including definitions and consumer-friendly terms, as well as a larger font, making it easier for your clients to read. It also includes step-by-step instructions on how to check the notice and spot for any potential fraud. 

2. Notice of Medicare Non-Coverage (NOMNC): Your clients may receive this notice when a provider or health plan believes Medicare will no longer continue to cover a service, specifically care from a skilled nursing facility (SNF), home health agency, or Comprehensive Outpatient Rehabilitation Facility (CORF). Your clients must get this notice at least two days before the provider or plan discontinues the service. The notice contains general information about the impending cut-off of Medicare coverage. More importantly, it instructs your clients on how to start an appeal if they do not agree with the provider or plan that they no longer meet the applicable Medicare coverage criteria.

3. Detailed Explanation of Non-Coverage (DENC): This notice contains more information about why the provider or health plan feels that Medicare would no longer cover the care being provided. Your client may get this notice after receipt of an NOMNC and once they have started the appeal process.

What is different about the revised NOMNC and DENC?

Before the redesign there were two versions of the NOMNC and DENC notices – one version for people in Original Medicare (Form No. 10123) and another version for those in Medicare Advantage plans (Form No. 10095). The revised versions now combine the previous notices so that anyone with Medicare receives the same type of notices regardless of how they get their Medicare benefits. Read the April 11, 2012 memo from CMS to all health plans explaining this change.

When do the revised notices take effect?

The revised MSN is now available online for your clients who use www.mymedicare.gov to view their personal Medicare information; otherwise, the paper version of the revised MSN will not start until January 1, 2013. Providers and Medicare Advantage plans are required to use the revised NOMNC and DENC as of May 1, 2012. 

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