This article was co-authored by Sheila Atwell, MSN and Melinda Gaboury, CEO.

Home health providers may find themselves bombarded by forms and paperwork on a daily basis and find it difficult to remain compliant in utilizing the most up-to-date forms. This blog will briefly discuss the current versions of the Home Health Change of Care Notice (HHCCN), Notice of Medicare Non-coverage (NOMNC), and the Advance Beneficiary Notice (ABN) forms.

The Home Health Change of Care Notice (HHCCN), Form CMS-10280 (approved 06/2016), replaces the HHABN Option Box 2 and the HHABN Option Box 3. Home health agencies are required to issue the HHCCN to Medicare beneficiaries in order to notify of plan of care changes. Triggering events include reductions or terminations in care. These events may occur due to physician/provider orders or limitations of the home health agency in providing a specific service. For example, if the POC contains orders for daily wound care and the provider writes a new order decreasing wound care to three times a week, the HHCCN is issued notifying the beneficiary of the reduction of service. If the POC contains orders to provide wound care once a week and the provider writes an order to discontinue all wound care, the HHCCN is issued notifying the beneficiary of the termination of the wound care service. Home health agencies may also experience the need to reduce or terminate services due to limitations such as when there is an unexpected staffing shortage. Termination of services may occur if the agency has lost staff of a particular discipline, such as OT and can no longer provided OT services. To access the HHCCN form and form instructions on the CMS website, click here.

If a termination involves ending all Medicare covered care with no further care to deliver, only issue the Notice of Medicare Non-coverage (NOMNC), Form CMS-10123 (approved 12/31/2011). Click here to access the NOMNC form and form instructions. The NOMNC is issued by the home health agency prior to the end of all Medicare covered services. The notice informs the beneficiary of the right to request a Quality Improvement Organization (QIO) review of the discharge and explains how the beneficiary can request an expedited determination from the QIO. One of the mistakes agencies make is not including the current information for the QIO on the form, as required. A Detailed Explanation of Non-Coverage (DENC), Form CMS-10124-DENC (approved 12/31/2011), is issued if the beneficiary requests an expedited determination. The DENC explains the specific reasons for the end of services. The DENC must be provided no later than close of business of the day of the QIO’s notification. This form will help the QIO decide if the agency is required to continue care vs. discharging the patient. Click here to access the DENC form and form instructions.

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 (expires 03/2020), replaces the HHABN Option Box 1 and is issued to notify the beneficiary that Medicare may not or will not pay for an item and/or service and informs the beneficiary of potential financial liability, should the patient agree to continue with the service. Reviewing the ABN with the beneficiary is necessary and should be delivered enough in advance to allow time for the beneficiary to consider the options. The ABN form and form instructions may be downloaded by clicking here.

For a brief description of situations requiring notice and which notice to issue,

For detailed information, refer to the Medicare Claims Processing Manual, Chapter 30. Suggested links:

HHCCN Form and Instructions
NOMNC Form and Instructions
ABN Form and Instructions
DENC Form and Instructions