Blog: Updates to CMS Beneficiary Notice Requirements Effective 1/1/25

On November 18, 2024, the Office of Management and Budget (OMB) renewed beneficiary notice requirements and released updated CMS beneficiary notification forms, including the Notice of Medicare Non-Coverage (NOMNC) and the Detailed Explanation of Non-Coverage (DENC). These forms will be required with Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries effective January 1, 2025.

Notice of Medicare Non-Coverage (NOMNC):

  • SNFs are required to provide to beneficiaries when FFS Medicare-covered service(s) end
  • Informs beneficiaries how to request an expedited determination
  • Provides enrollees fast-track appeal rights (for Medicare Advantage plans)

Detailed Explanation of Non-Coverage (DENC):

  • Given to beneficiary if requesting an expedited determination
  • Provides explanation behind the end of coverage
  • Includes updated instructions regarding MA plans where a prior favorable appeal decision was received during the current episode of care
    Note: MA plans must detail specific changes that led to the termination of services decision.

The Point Is: Providers and Beneficiaries have financial liability and appeal rights under FFS and Medicare Advantage programs. To protect everyone, it is critical that team members responsible for providing notifications to beneficiaries receive these updates and are prepared to implement them by January 1, 2025, as required by CMS

Click here for detailed instructions, copies of the updated forms, and to access additional mandated notifications.

Please let us know if we can be of further help.

Share the Word

Join Our Mailing List!

Bee Pillar

Hive-Mentality

Person Pillar

Patient-Centered

Quality Pillar

Quality Solutions

Skip to content