When covered skilled nursing services are ending, the facility should provide a written Notice of Medicare Non-Coverage explaining the end date and fast-appeal instructions. Act immediately because the deadline is tied to the date on the notice.
How to compare facilities step by step
- Read the notice immediately. Check the coverage end date, reason, appeal contact, deadline, and potential financial responsibility.
- Ask for the clinical explanation. Request the detailed reason skilled services are considered no longer reasonable and necessary or no longer covered.
- Request a fast appeal on time. Follow the notice instructions and contact the listed BFCC-QIO by the stated deadline if the patient believes services are ending too soon.
- Build a parallel care plan. While the review is pending, compare home health, outpatient therapy, assisted living, Medicaid, private-pay care, or another clinically appropriate setting.
- Confirm financial responsibility. Ask what charges begin after the coverage end date and how the appeal decision changes responsibility.
A Notice of Medicare Non-Coverage starts the fast-appeal timeline
For covered services ending in a skilled nursing facility, the patient should receive a Notice of Medicare Non-Coverage at least two days before services end. The notice states the end date and explains how to contact the Beneficiary and Family Centered Care Quality Improvement Organization for a fast appeal.
Medicare instructs patients in these settings to follow the notice and request the fast appeal no later than noon on the day before the listed termination date. Medicare Advantage procedures can differ, so follow both the notice and the plan instructions.
Coverage can end even before day 100
The Part A SNF benefit covers up to 100 days per benefit period, but only while skilled services remain covered. Coverage may end when the care is no longer medically reasonable and necessary, when the need becomes custodial, or when another eligibility requirement is no longer met.
Plan the next safe setting while the appeal is reviewed
Ask the interdisciplinary team to document the current nursing, therapy, medication, mobility, cognitive, equipment, and caregiver needs. Compare the next setting against those needs and identify who will pay for each service if Medicare SNF coverage ends.
Frequently asked questions
Can I appeal when Medicare SNF coverage ends?
Yes. If you believe covered SNF services are ending too soon, follow the Notice of Medicare Non-Coverage instructions to request a fast appeal by the deadline.
How much notice should a skilled nursing facility give?
Medicare says patients in these settings should receive a Notice of Medicare Non-Coverage at least two days before covered services end.
Does reaching day 100 always cause coverage to end?
Day 100 is the maximum under the Part A SNF benefit for a benefit period. Coverage can end earlier if the skilled-care requirements are no longer met.