MEDICARE BENEFICIARY NOTICES GUIDELINES	(2/24)

ABN: Advance Beneficiary Notice
(financial liability notice)	
HHCCN: Home Health Change of Care Notice	NOMNC: Notice of Medicare Non-Coverage
(appeals notice)	
•	Triggering events: Initiation, Reduction & Termination of Services

•	Notice provided to traditional Medicare beneficiaries (Fee-for-Service; FFS) and all Medicare Advantage/HMO/MSHO to inform them of any financial liability they may have for services that home health believes will not be covered by Medicare

•	ABN must be re-issued at least annually; expires one year from signature date	•	Triggering events: Initiation, Reduction & Termination of Services

•	Notice provided to traditional Medicare beneficiaries (Fee-for-Service; FFS) and to all Medicare Advantage/HMO/MSHO to inform them of changes in their plan of care to include reductions in care, not outlined on the original plan of care, or to give notice of termination based on agency reasons	•	Informs the client that their Medicare covered services are ending, as well as what their appeal rights are

•	Notice must be provided at least 2 calendar days prior to discharge from all Medicare covered service(s)

•	Applies to traditional Medicare beneficiaries and those covered under a Medicare Advantage/HMO/MSHO plan.

•	Medicare Secondary Payer (MSP) for traditional Medicare and Medicare Advantage/HMO/MSHO:
provide ABN also if client does not meet Medicare coverage criteria; could occur on admission or after	
*Medicare Advantage/HMO/MSHO plans in MN follow Medicare guidelines for Home Health and require the above forms to be utilized the same as traditional Medicare per their policy manual.

ABN, HHCCN and NOMNC NOT REQUIRED IN THE FOLLOWING SITUATIONS:	
•	Frequency/duration increasing or new discipline added
•	Reduction requested by client and clearly documented in the clinical record
•	Client refuses services and is clearly documented in the clinical record	•	Client being transferred to another level of care or agency/provider
•	A missed visit occurs
•	Dietician, telehealth and chaplain services	

INITIATION OF SERVICES	ABN	HHCCN	NOMNC	

One time BILLABLE PT assessment visit; no other services are being initiated	
Not Required	
Not Required	X
Notice date is assessment date	
Skilled assessment – client does NOT meet Medicare criteria, but services will be initiated and billed to another payer	
X	
Not Required	
Not Required	

Skilled Assessment- client not admitted for services (e.g. does not meet Medicare criteria, refused services, etc.)	
Best Practice	
Not Required	
Not Required	
Client admitted for SKILLED services under Medicare as well as non-covered services billed to another payer	X	Not Required	Not Required	
Client admitted for paraprofessional services – only	X	Not Required	Not Required	
Non-covered services paid for by a payer other than Medicare & are initiated at some point during the episode	X	Not Required	Not Required	
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INITIATION OF SERVICES	ABN	HHCCN	NOMNC	
Home care believes Medicare will NOT cover services at the frequency ordered by MD (e.g. MD orders PT 5 x
week; only 3 x week considered reasonable & necessary based on the client’s condition)	X	
Not Required	
Not Required	
Any time services are reduced that do not follow the original plan of care based on administrative or MD orders	Not Required	X	Not Required	
At recertification, there is a reduction in the discipline or frequency of services from what was being provided
at the end of the certification period	
Not Required	X	
Not Required	
Services placed on “HOLD” (e.g. PT on hold until weight bearing status is upgraded)	Not Required	X	Not Required	
Your discipline is discharging as ordered (duration), but other skilled services are continuing	Not Required	Not Required	Not Required	
Upon Resumption of Care, the frequency of services is reduced from what was previously ordered	Not Required	X	Not Required	
Upon Resumption of Care, a discipline that was previously ordered is not resumed	Not Required	X	Not Required	

TERMINATION OF SERVICES	ABN	HHCCN	NOMNC	
All Medicare services are being discontinued; no other services continuing (e.g. medical condition has
stabilized, no longer homebound, MD has ordered discharge, goals achieved, etc.)	Not Required	Not Required	X	
All Medicare services are ending because client no longer meets Medicare criteria, but services that are
typically covered by Medicare will continue or be initiated under another payer	X	Not Required	X	
Client transfers to another level of care/provider (hospital, SNF, hospice, home care agency)	Not Required	Not Required	Not Required	
Termination based on AGENCY reason(s) – NOT Medicare coverage/criteria (e.g. unsafe client/employee
situation, staff resource issue, lack of F2F)	Not Required	X	Not Required	
Unanticipated discharge (e.g. client seen in clinic and MD calls and DC’s home care; phone call or upon
arrival that client is no longer homebound	Not Required	Not Required	X	
Termination of a service under Medicare (even if another Medicare covered skilled service is continuing) but
continuing the service under a new payer (payer change; no longer Medicare)	X	Not Required	Not Required	

AMENDING BENEFICIARY NOTICES	

What do I do if any of the beneficiary notices have been given, but the date for the planned discharge changes?	•	Inform the client of the new date
•	Draw a single line through coverage end date; write new date above or beside the deleted date
•	Write the words “Notice Amended” on the notice
•	Date and sign the entry
•	Amend the notice in the client’s clinical record in the same manner	

REFUSAL OF CLIENT TO SIGN ABN, HHCCN OR NOMNC	

What do I do if the client/representative refused to sign an ABN, HHCCN or NOMNC?	•	Document on the form the client or representative refused to sign the document
•	Date the entry and sign your name & title by the entry
•	Leave a copy of the form with the client or representative
•	Client refusal to sign needs to be witnessed by 2 people either in person or by phone and documented	
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