What to Do When You Receive a Medicare Non-Coverage Notice in a Nursing Facility

If a Florida nursing facility hands you a Notice of Medicare Non-Coverage, act quickly, because you usually have only two days to protect your coverage. The notice means the facility plans to stop billing Medicare for skilled care it believes Medicare will no longer pay for. You have three choices in response. You can request a fast appeal and keep the care while a reviewer decides, you can keep the care and pay privately, or you can accept the discharge. What the outcome turns on comes down to three things. It depends on whether you appeal in time, whether your doctors and therapists support continued skilled care, and whether the facility even delivered a valid notice in the first place. Miss the deadline and you may owe for the care yourself, so this notice deserves immediate attention. Below is what the notice is, your options, and how the appeal works.

What is a Notice of Medicare Non-Coverage?

A Notice of Medicare Non-Coverage, often shortened to NOMNC, is a formal notice from your nursing facility that it plans to stop billing Medicare for services it believes Medicare will no longer cover. Federal rules at 42 CFR § 405.1200 require the facility to deliver this notice at least two calendar days before the coverage is set to end, so you have time to respond. The current version of the form was last updated by Medicare in January 2025.

Why do facilities issue these notices? Some worry about fines from Medicare for providing care that might later be deemed unnecessary. In other cases, a facility may be looking for a reason to discharge a patient. Because Medicare and Medicaid cover very different things, families sometimes assume care must stop when Medicare does, but the difference between Medicare and Medicaid often means another payor can step in. Either way, the notice starts a clock, and the smart move is to know your options before it runs out.

Your Three Options When You Receive This Notice

When the notice is handed to you, you have three choices.

1.   Keep the care and require the facility to bill Medicare. This choice lets you continue the current care while challenging the facility's determination through a fast appeal.

2.   Keep the care without billing Medicare. Here you acknowledge Medicare will not cover the services and you agree to pay privately.

3.   Decline the care and leave the facility. This is usually chosen by people who agree they no longer need skilled care or are ready to be discharged.

How the Fast Appeal Works in Florida

Choosing the first option triggers a fast appeal, also called a skilled service termination appeal, through Florida's Beneficiary and Family Centered Care Quality Improvement Organization, the BFCC-QIO. In Florida that organization is now Acentra Health, formerly Kepro. Acentra Health is a government-contracted reviewer that decides disputes about whether Medicare should keep paying, and its physician reviewers look at the medical record to make the call.

You, or someone helping you, contact Acentra Health directly using the phone number printed on the notice, and the review moves quickly, often decided by the end of the day after the reviewer receives the records it needs. Medicare's own guide to fast appeals walks through the same steps. There is an important protection built in for Florida residents. While your appeal is pending, the nursing facility cannot bill you personally and must wait for Acentra Health's decision before assigning any financial responsibility.

How to Prepare a Strong Appeal

Do not appeal based only on a feeling that the care is still needed. To give a Florida appeal the best chance, build a record before the coverage end date.

• Get support from the doctor who prescribed the skilled care.
• Collect statements from the therapists actually providing the care.
• Gather documentation showing improvement, or showing that the care prevents deterioration.
• Line up medical professionals who are ready to speak with Acentra Health during the review.

The standard is not only whether the patient is improving. Skilled care that maintains a condition or prevents decline can also qualify, and framing the medical evidence that way often makes the difference.

The Financial Risk to Weigh

There is a real financial stake in the decision. If your fast appeal is denied, you become personally responsible for the cost of services received after the notice period, meaning after the two days following the notice. That exposure is exactly why strong, specific medical support matters so much, and why it is worth acting the same day the notice arrives rather than waiting. If private-pay costs become the reality, life care planning can map out how to cover ongoing care without draining a lifetime of savings.

What If the Facility Fails to Give Proper Notice?

Timely, valid notice is not just a formality. If a nursing facility fails to deliver the required Notice of Medicare Non-Coverage, it generally cannot hold you financially responsible for the continued services, no matter how Medicare ultimately rules on coverage. This protection matters because the facility carries the burden of getting the notice right. If you are also weighing how to pay for ongoing care, it often connects to a broader Florida Medicaid and long-term care plan, since Medicaid may step in where Medicare coverage ends.

Key Takeaways

• A Notice of Medicare Non-Coverage (NOMNC) must be delivered at least two calendar days before skilled Medicare coverage ends, under 42 CFR § 405.1200.
• You have three options: fast appeal and keep billing Medicare, keep the care and pay privately, or accept discharge.
• The fast appeal in Florida goes through Acentra Health, formerly Kepro, and the facility cannot bill you while it is pending.
• If the facility never gave you a valid notice, it generally cannot make you pay for the continued care.

Frequently Asked Questions

Q. What is a Notice of Medicare Non-Coverage?

A. It is a formal notice, called the NOMNC, that a skilled nursing facility must give you at least two calendar days before Medicare-covered skilled services are scheduled to end. It tells you when coverage stops and how to request a fast appeal. The requirement comes from 42 CFR § 405.1200.

Q. Who handles the Medicare fast appeal in Florida?

A. Acentra Health, formerly Kepro, the federally contracted Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Florida. You contact them directly to ask for the fast appeal, and their physician reviewers decide whether skilled services should continue.

Q. Will I have to pay while my appeal is pending?

A. No. While the fast appeal is under review, the facility cannot bill you personally. You become financially responsible only for services after the notice period if the appeal is ultimately denied, which is why strong medical support matters.

Q. What if the facility never gave me the notice?

A. If a nursing facility fails to deliver a valid Notice of Medicare Non-Coverage, it generally cannot hold you financially responsible for the continued services, regardless of Medicare's final coverage decision. Proper, timely notice is a condition of shifting cost to you.

Q. How fast is the appeal decided?

A. Very fast. The BFCC-QIO typically decides by the end of the day after it receives the information it needs. That is why gathering doctor and therapist support immediately, before the coverage end date, is so important.

Respond to a Non-Coverage Notice With Confidence

If you or a parent just received a Notice of Medicare Non-Coverage anywhere in Florida, moving quickly protects both the care and your wallet. Start by writing down the exact date and time the notice was handed over, because the two-day clock and the question of whether notice was even valid both depend on it. Next, call the doctor and therapists right away and ask them to document why skilled care should continue, since that evidence is the heart of any fast appeal. Then talk with a Florida elder law attorney about the appeal and about how care gets paid for if Medicare coverage really is ending. The benefit, in plain terms, is control. You keep covered care while the appeal is decided, you avoid surprise bills, and you have a plan for what comes next. Elder Needs Law, PLLC serves families throughout Florida, and the sooner you act after the notice, the more options stay open.

When you are ready, you can request a consultation through our contact page.