CaseWhy Hub · CaseWhy Appeals · Facilities · Skilled nursing · Mid-stay
When the plan ends a resident's covered stay
The resident gets a Notice of Medicare Non-Coverage, and the fast appeal has to be requested by noon the day before coverage ends. CaseWhy Appeals explains the notice to the family, writes the request, and tracks the clock.
The clock, precisely
The NOMNC (CMS-10123) must be delivered at least two days before covered services end. The family must ask the Quality Improvement Organization for a fast review no later than noon of the day before services end. If they make that deadline, coverage generally continues while the QIO decides — and the QIO decides quickly.
That is the whole mechanism, and the reason it fails is almost never that the family didn't care. It's that the notice arrived on a Friday, the number on it goes to a recording, and nobody in the building had the time to sit down and explain what the form actually means.
Why this is your problem too
An appeal that succeeds keeps a resident in a covered bed while it is decided. An appeal that is never filed ends the stay on schedule. Your census, your discharge planning, and your relationship with the family all sit on the same side of that outcome as the family does.
What the building sees
One board for the whole facility, sorted by what runs out first. A reference and a tag are how a case is found — the resident's name is never typed in, so nothing identifying is stored here at all.
The other way a plan denies a resident: the admission flow — notice, letter, CMS-1696 →