Page 61 - Clinical Managers Orientation Binder

6/28/2019

Regulations: Medicare Notices &

Appeals

Traditional Medicare Managed Medicare

NOMNC: Notice of Medicare Non-Coverage NOMNC: Notice of Medicare Non-
Coverage
1.Issue at least 2 calendar days prior to ending
Medicare billing and/or Discharge 1. Issue at least 2 calendar days
before discharging patient
2.Triggers patient appeal rights
2. Triggers patient appeal rights
ABN: Advance Beneficiary Notice
1.Issue when Medicare may not cover
a. Patient no longer meets SHIP
BOTH Traditional & Managed:
b. Used to establish patient financial liability LIVANTA APPEAL: Patient has the
for payment or to change billing source
right to request an Expedited
Determination (APPEAL) of discharge
HHCCN: Home Health Change of Care
Notice
1. Issue before decreasing or ending services *See Cheat Sheet in Binder & Intranet for 19
notice details
outside plan of care

HIPAA Compliance

Health Insurance Portability and Accountability Act
1. HIPAA law passed in 1996

HITECH revised after HIPAA
1. Helps make better decisions to protect confidential health
information
2. Explains/describes patient rights over PHI
3. Set standards for payment related transactions and privacy and
security of patient/member information
4. Extends patient rights over maintenance & release of their records
Email Requests: Records Requests or Medical Records
To contact the HIPAA Compliance Team, email:
HIPAAandPrivacy.Team@vnsny.org
20

10