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HOME ► Appeals
Appeal Types
Medicare Notice of Non-Coverage
Medicare Fee-For-Service (FFS), Medicare Advantage (MA) beneficiaries and health care providers have certain rights and protections related to financial liability.
When a decision occurs that will affect the Medicare beneficiary continuity of current health care service or financial liability, the health care provider must issue a Medicare Notice of Non-Coverage to the patient or appropriate patient representative to notify them of their appeal rights and protections.
The process of issuing a Notice of Non-Coverage promotes education and allows them to exercise individual responsibilities by becoming pro-active partners in their own health care decisions.
| The notice of non-coverage process is designed to: |
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Termination of Medicare covered services is defined as discharge from a residential provider or complete cessation of coverage at the end of a course of treatment. This does not include a reduction of service or exhaustion of benefits.
All Hospitals, Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), Center Outpatient Rehabilitation Facilities (CORF), Hospice and Swing Beds providers are impacted by these regulations and must issue Notices of Non-Coverage to all Medicare beneficiaries when the end of all covered care is foreseen. The notices to be used are prescribed by Centers for Medicare & Medicaid Services (CMS) and must contain the information for the beneficiary or their representative to contact the Quality Improvement Organization (QIO) to request an expedited appeal.
The provider is required to work with the beneficiary to complete and sign the notice acknowledging receipt of the notice, assuring that the beneficiary understands the end of a covered service(s) is imminent. This notice must be given to the beneficiary before their Medicare coverage in a particular setting will end. If the beneficiary accepts the provider's determination on termination, no additional action is required.
| In the event of a disputed termination of Medicare covered service, CMS regulation mandates an Expedited Appeal process involving beneficiaries, providers, Quality Improvement Organizations (QIO), and other entities. The process of an expedited appeal is as follows: |
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As prescribed by these regulations, all parties are required to respond within dictated time frames when a Medicare beneficiary or beneficiary representative requests an Expedited Determination, including weekends and holidays.
HealthInsight Contact Information
Our Business Hours are: 8:00 a.m. - 4:30 p.m. (Pacific Time)
For additional assistance please contact
HealthInsight’s Appeals Review Coordinator
Telephone: (800) 748 - 6773
Fax: (800) 741 - 7532
E-mail questions can be directed to appeals@healthinsight.org.
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