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Updated NOMNC and DENC Must Be Used Starting Jan. 1, 2025
Updated NOMNC and DENC Must Be Used Starting Jan. 1, 2025
The Office of Management and Budget (OMB) updated the Notice of Medicare Non-Coverage (NOMNC), (Form CMS-10123), and the Detailed Explanation of Non-Coverage (DENC), (Form CMS-10124). Providers must use the current notices until Dec. 31, 2024, and are required to use the new NOMNC and DENC beginning Jan. 1, 2025.
Please note the following important updates to the NOMNC and DENC, which affect Medicare Advantage (MA) enrollees only:
Notice has been modified to reflect updated regulations for appeal rights when an untimely request for appeal has been made.
Current instructions refer the MA enrollee to contact the MA plan directly for appeal options if the expedited appeal time frame has been exceeded.
New instructions, effective Jan. 1, 2025, instruct the MA enrollee to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for appeal options.
The DENC instructions have been updated:
New instructions specify what health plans are needed to complete the DENC.
Special instructions have been added for repeat appeals within the same episode of care.
If the enrollee has previously received a favorable BFCC-QIO appeal decision during the current episode of care, detail the specific change(s) in the enrollee’s condition since the previous appeal that provides the basis for this decision to terminate services.
The updated NOMNC and DENC, which go into effect on Jan. 1, 2025, are available here:
For full instructions for Original Medicare, also known as Fee-for-Service (FFS), expedited determination processes are available in section 260, of chapter 30 of the CMS Medicare Claims Processing Manual.
Enhanced Barrier Precautions (EBP) to prevent infections
Enhanced Barrier Precautions (EBP) to prevent infections
The Centers for Medicare & Medicaid Services (CMS) recently issued new guidelines on Enhanced Barrier Precautions (EBP) to prevent infections in skilled nursing facilities. To help skilled long-term care teams navigate these requirements, the Association for Professionals in Infection Control and Epidemiology (APIC) and AAPACN have collaborated to create a free practice guidance tool and resource guide designed specifically for your needs.
These tools will help you:
Understand when and how to implement EBP for residents
Apply infection control recommendations during high-contact care activities like bathing, dressing, and toileting
Reinforce learning with case studies and self-assessments
Access a comprehensive list of infection control references
CMS estimates that more than half of nursing home residents are colonized with multidrug-resistant organisms (MDROs). Implementing EBP correctly can save lives and ensure compliance with new regulations.
Download these free tools today and ensure safer care for your residents.
On Topic: Urinary Tract Infections (provided by PALTCmed) Association
On Topic: Urinary Tract Infections (provided by PALTCmed) Association
Urinary Tract Infections (UTIs) are the most common type of bacterial infections in adults over the age of 65. They impact many individuals living in post-acute and long-term care settings, particularly older women and individuals with indwelling urinary catheters. Untreated, these infections can have severe consequences such as kidney failure or sepsis. PALTmed has a Clinical Topics Page on UTIs as well as several valuable resources, including:
Pocket Guide
Podcasts
Clinical Alert
Caring for the Ages Articles
JAMDA Articles
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