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Beneficiary Notices Initiative (BNI)

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Use the navigation links on the left side of this page or in the table below to access the financial liability and appeal notices and their instructions:
  • FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
  • FFS Home Health Change of Care Notice (FFS HHCCN)
  • FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNF ABN)
  • FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
  • FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility  (FFS Expedited Determination Notices)
  • MA Denial Notices (MA Denial Notices)
  • MA Expedited Determination Notices (MA Expedited Determination Notices)
  • Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)

Notice

Medicare Program

Type of Notice

Provider Type

Purpose

Link to Notice

Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131)

FFS

Financial Liability Notice

Healthcare providers (including independent laboratories, HHAs, and hospices), physicians, practitioners, and suppliers paid under Medicare Part B

Issued in order to transfer financial liability to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case.

ABN, Form CMS-R-131

 

ABN Form Instructions

Home Health Change of Care Notice (HHCCN, Form CMS-10280)

FFS

Care Changes

HHAs

Issued to beneficiaries receiving home health care benefits for notification of plan of care changes.

HHCCN, Form CMS-10280

 

HHCCN Form Instructions

Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, Form CMS-10055)

FFS

Financial Liability Notice

SNF

Issued in order to transfer financial liability to beneficiaries before the SNF provides an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or is custodial in nature.

SNF ABN, Form CMS-10055

 

SNF ABN Form Instructions

Hospital-Issued Notices of Non-coverage (HINNs)

FFS

*HINN 10 may be used for MA

Financial Liability Notices

Hospitals

Issued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case. There are currently four different HINNs.

HINNs

Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123)

FFS & MA

Expedited Determination Notices

HHAs, SNFs, Hospices, and CORFs

Informs beneficiaries of their discharge when their Medicare covered services are ending.

NOMNC, Form CMS-10123

 

NOMNC Form Instructions

Detailed Explanation of Non-Coverage (DENC, Form CMS-10124)

FFS & MA

Expedited Determination Notices

HHAs, SNFs, Hospices, and CORFs

Given only if a beneficiary requests an expedited determination. Explains the specific reasons for the end of services.

DENC, Form CMS-10124

 

DENC Form Instructions

Important Message from Medicare (IM, Form CMS-R-193)

FFS & MA

Hospital Discharge Appeal Notices

Hospitals

Informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights.

IM, Form CMS-R-193

 

 

Detailed Notice of Discharge (DND, Form CMS-10066)

FFS & MA

Hospital Discharge Appeal Notices

Hospital or MA Plan

Issued to beneficiaries who choose to appeal a discharge decision.

DND, Form CMS-10066

Integrated Denial Notice (IDN, Form CMS-10003)

MA

Denial Notices

Medicare Health Plans

Issued upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment.

IDN, Form CMS-10003

IDN, Form CMS-10003 Spanish

 

IDN Form Instructions

Medicare Outpatient Observation Notice (MOON)

FFS & MA

Hospital notice of observation services and are not inpatients

Hospital or MA Plan

Issued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).

MOON, Form CMS-10611

MOON Instructions

Medicare Outpatient Observation Notice (MOON)

The MOON is a standardized notice to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).  

The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015.  The NOTICE Act requires all hospitals and CAHs to provide written and oral notification under specified guidelines.

Medicare Outpatient Observation Notice and accompanying form instructions are available in “Downloads” below. 

Frequently asked questions ("MOON FAQs") are available under "Downloads" below.

Full instructions related to MOON implementation ("CR9935 MOON Instructions") are available under “Downloads” below. The MOON instructions will be included as Section 400 of Chapter 30 of the Medicare Claims Processing Manual. 

CMS informed Medicare Advantage plans of the MOON instructions via a Health Plan Management System email blast.  MA plans are to follow the MOON instructions available under "Downloads" below.

All hospitals and CAHs are required to provide the MOON, per CMS guidance, beginning no later than March 8, 2017.

See "Federal Register - IPPS - NOTICE Act Final Rule" in "Related Links" below to view the final NOTICE Act regulation (Section L and 42 CFR 489.20). 

Questions?

Questions regarding any of the Fee For Service BNI notices may be sent to our mailbox: BNImailbox@cms.hhs.gov.

Send questions regarding Medicare Advantage notices to: Part_C_Appeals@cms.hhs.gov

Send questions regarding the MOON to: MOONMailbox@cms.hhs.gov.

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