Hospice Says Medicare Will Stop Paying. Find the Notice Before Care Ends

The first warning may sound informal: your parent has stabilized, the team is discussing discharge, or the next benefit period may not be certified. Treat that conversation as the start of a short paperwork runway. Ask one direct question: “Is the hospice deciding that Medicare-covered hospice services will end?”

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

If the answer is yes, do not settle for a calendar entry or a verbal explanation. You need the written Medicare notice, its coverage end date, and the appeal telephone number printed on it. Medicare says a person who believes hospice services are ending too soon may request a fast appeal from an independent reviewer. The instructions and deadline come from the notice, not from a general conversation with the hospice. Medicare explains the fast appeal process here.

Who pays

Medicare Part A pays the Medicare-approved hospice for covered hospice services while your parent remains eligible and has elected the hospice benefit. Care for the terminal illness and related conditions generally must be provided or arranged by that hospice. Medicare can continue covering unrelated health problems outside the hospice benefit, subject to the ordinary coverage and cost-sharing rules. Check Medicare’s hospice coverage page before assuming that every service or drug belongs on the hospice bill.

A hospice discharge does not by itself prove that every kind of Medicare coverage has ended. It means the hospice benefit is ending with that provider under the stated reason. Ask the hospice to identify what it will stop furnishing, which prescriptions and equipment it arranged, and what must be transferred to another prescriber or supplier. Ask your parent’s physician what care is clinically required after discharge. The physician owns that clinical decision.

Watch for a request that your parent sign a voluntary revocation when the hospice is actually making the decision to discharge. Those are different events. Ask the hospice to state in writing whether this is a patient revocation, a transfer to another hospice, or a hospice-initiated discharge. Do not sign a revocation merely to make the office paperwork easier. If you cannot tell what a document changes, stop and get help before signing.

If services continue after the coverage end date and the appeal does not preserve payment, your parent may be responsible for the charge. Before agreeing to private payment, call the hospice billing office. Ask which services can continue, the unit used for billing, the private-pay rate, what is excluded, when billing begins, and whether any deposit is refundable. Request the same terms in writing. This desk does not publish a rate because the number has to come from the entity that will send the bill.

The papers

The first paper is the Notice of Medicare Non-Coverage, Form CMS-10123. It is commonly called the NOMNC. It should identify the service ending, the effective coverage end date, and the Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO, that takes the fast appeal. CMS identifies the NOMNC as the notice used when Medicare-covered hospice, home health, skilled nursing facility, or comprehensive outpatient rehabilitation services are ending. CMS posts the form and its instructions here.

Check the completed notice before filing it:

1. Is your parent’s name correct?
2. Does it say hospice services are ending?
3. Is the coverage end date filled in and readable?
4. Is the BFCC-QIO telephone number present?
5. Does the notice say when the call must be made?
6. Did the hospice give your parent a copy?

A signature on the NOMNC records receipt of the notice. It is not the place to explain why you disagree. Keep a photo or scan of every page and write down when and how it was delivered. If the hospice asks for a signature but will not provide a completed copy, ask for the copy before the paper leaves the room.

If you request the fast appeal, the hospice or Medicare plan must provide a Detailed Explanation of Non-Coverage, Form CMS-10124, commonly called the DENC. That second notice should state the facts used in the decision, the specific coverage rule being applied, and why the hospice believes your parent no longer meets it. CMS describes both notices in its Beneficiary Notices Initiative.

Build one appeal packet, even if the reviewer initially accepts the request by telephone. Put in the NOMNC, the DENC when it arrives, the hospice election statement, the current plan of care, recent hospice visit notes you can obtain, medication and equipment lists, and the names of the hospice medical director and attending physician. Add a call log with the person reached, telephone number, time, and promised next step.

Your job is to organize the record, not to make a prognosis. Ask the physician who knows your parent to address the clinical facts and the hospice eligibility question. If you are not already authorized to act for your parent, ask the BFCC-QIO what authorization it needs. Medicare recognizes appointed representatives, but you should not let uncertainty about a representative form consume the deadline printed on the NOMNC. Follow the reviewer’s instructions during the call.

The runway

The early failure pattern is a series of hints without a notice: fewer visits, talk about “graduating,” questions about taking over medications or equipment, or a proposed final visit with no coverage paper. When any of those appears, ask whether a discharge decision has been made and request the NOMNC if covered services are ending.

Once the notice arrives, work in this order:

First, read the deadline aloud and call the BFCC-QIO number printed on the notice if your parent wants a fast appeal. Medicare instructs people outside a hospital setting to follow the NOMNC and request the fast appeal no later than the deadline stated there. Missing it can change the review path and who may owe for later services.

Second, tell the reviewer exactly what you are appealing: the termination of Medicare-covered hospice services on the date shown. Record the case or confirmation number and ask when the decision is expected.

Third, ask the hospice for the DENC and the records it supplied to the reviewer. Compare the DENC with the current plan of care and physician documentation. Flag missing records, incorrect patient information, or statements that do not match the chart. Send clinical disagreements to the treating physician for a response.

Fourth, make a transition list that does not depend on winning the appeal. For every drug, oxygen item, bed, supply, after-hours number, and scheduled visit, write who provides it now and who will be responsible after the stated end of hospice coverage. Do not assume equipment can remain or that an outside prescription is already active.

Fifth, ask who will receive the decision and by what method. Keep the telephone available and check messages. If the reviewer agrees that services should end, ask what further review rights exist and when financial responsibility may begin. Medicare says services furnished before the NOMNC coverage end date are not shifted to the beneficiary merely because the reviewer agrees with the termination. Services continued afterward may become the beneficiary’s responsibility. Use Medicare’s payment explanation to check the boundary.

Free help

Missouri SHIP provides free, unbiased Medicare counseling. A counselor can help you read the NOMNC, identify the appeal contact, and prepare questions about Medicare procedure. Missouri SHIP describes its counseling services here. You can also use this desk’s local help directory to find the appropriate starting point.

Call the BFCC-QIO listed on the NOMNC for the fast appeal itself. Call the hospice billing office for any private-pay rate or deposit. Call the physician for the medical assessment and documentation. Those are three different jobs, and one office’s answer does not substitute for another’s.

If the dispute turns into a contract question, a demand that you personally guarantee payment, or a disagreement over who has authority to sign for your parent, stop at that line and take the actual documents to a lawyer. The appeal reviewer decides Medicare coverage. The physician addresses the clinical record. A lawyer addresses legal authority and contract liability.