CMS recently approved a renewed ABN form (to be implemented no later than 8/31/20), but the NOMNC form has not been updated.
You can find all current beneficiary forms at the following website:
https://www.cms.gov/Medicare/Medicare-General-Information/BNI
To my knowledge, the CMS approved NOMNC form has not changed since last approved 12/31/2011, however the BFCC-QIO for MN changed from KEPRO to Livanta effective 6/8/2019, so that may be why your agency has a
revision date listed from 2019.
Jennifer Stark, RHIA
Health Information & Compliance Coordinator
Home Care & Hospice
220 North 6th Ave. East | Duluth, MN 55805
Phone: 218.249.6147 | Fax: 218.249.6166
jennifer.stark@slhduluth.com
From: billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org]
On Behalf Of Rettig, Lynette
Sent: Monday, July 13, 2020 11:11 AM
To: billers@list.mnhomecare.org
Subject: CMS 10123 NOMNC 7-15-19
CAUTION: External Sender - This email originated from outside of
St. Luke's.
Please do not click links or open attachments unless you recognize the sender and know the content is safe.
Our manager read about a updated version of the Medicare non coverage notice
We are using Form CMS 10123-NOMNC effect7-15-19- can you verify that this is the most current version
Thank you
Lynette Rettig
Billing Supervisor
Ridgeview Home Health Services
501 S. Maple St STE 1
Waconia MN 55387
952-442-6030 Ext 35520