Notice of Medicare Non-Coverage and Detailed Explanation of Non-Coverage Letter Requirements

Activity description

Medicare health plans must meet the notification requirements for organization determinations and appeals processing under the Medicare Advantage regulations. Different types of letters are sent depending on the health care setting. Notice of Medicare Non-Coverage (NOMNC) is issued when a member in skilled care no longer requires continued skilled services. Whereas a Detailed Explanation of Non-Coverage (DENC) explains the specific reasons for the end of covered services and is sent in the event a NOMNC is appealed. This activity will describe the notification requirements and appropriate use of letters for the denial or termination of medical coverage.

Provided by
This activity is provided by OptumHealth Education and Optum Care.

Commercial support
No commercial support was received for this activity.

Hardware/Software Requirements
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Target Audience

This activity is designed to meet the educational needs of nurses and physicians interested in Centers for Medicare and Medicaid Services (CMS) notification requirements and the appropriate use of different types of letters used depending on the health care setting.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Define NOMNC, DENC, Notice of Denial of Medical Coverage (NDMC) and Detailed Notice of Discharge (DND).
  • Discuss CMS requirements for timelines and templates for NOMNC, DENC, NDMC and DND.
  • Differentiate between the types of letters sent to the member, depending on the health care setting.
Activity summary
Available credit: 
  • 1.00 AMA
  • 1.00 ANCC
  • 1.00 Attendance
Activity opens: 
09/15/2021
Activity expires: 
09/15/2024

Faculty/Planners
Sarah Chart, RN
Vice President
OptumHealth Education

Karen Davidson, BSN, RN, CCM
Training Consultant
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Rebecca Gleason, RN, CCM
Clinical Planner
OptumHealth Education

Lolly Bilous, MSN, RN, CCM
Associate Director 
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Georgina Perez, BSN, RN, CCM
Training Consultant 
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Tiffany Younts, MSN, RNC-OB, CCM
Training Consultant 
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty or planners have no financial relationships to disclose.

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation Statement
Joint LogoIn support of improving patient care, this activity has been planned and implemented by OptumHealth Education and Optum Care. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit Designation Statements

Nurses
The participant will be awarded up to 1.00 contact hours of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

Physicians
OptumHealth Education designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PAs
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.

Available Credit

  • 1.00 AMA
  • 1.00 ANCC
  • 1.00 Attendance
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