How does the platform deliver NOMNC and ABN notices on time so Medicare appeal exposure stays inside the rules?
Roadmap — not built
The platform does not yet ship a dedicated module for this workflow. The “How the platform is designed to run it” description below reflects designed-and-planned behavior, not currently shipping code. Outcome figures are modeled targets.
Design target · Expected outcome
Late-notice liability → zero
Design target modeled from workflow design. No operator community has been measured, no approved Evidence Record supports it, and business outcomes remain contributory — figures are targets, not results. See Industry Findings for methodology.
Incumbents this workflow touches
Proposed in-platform scope: Paper NOMNC delivered late or not at all
Roadmap integration targets (not live): Medicare appeals tracking · Hospital case management
The operator may retain existing systems or select SeniorCRE for defined functions. Alongside existing systems, this workflow would depend on approved source access, implementation and operator acceptance. Named vendor integrations are roadmap targets, not completed connections.
The problem
Medicare requires a Notice of Medicare Non-Coverage at least two calendar days before the end of covered services, and an ABN when the operator believes Medicare will not cover a service. Late or missing notice converts into liability the operator absorbs. On a fragmented stack the notice is a paper form the social worker hopes the family signed.
How the platform is designed to run it
The platform schedules NOMNC and ABN delivery against the projected end-of-coverage date the moment the discharge plan is set. The form generates from the resident record, captures the signature on device, and posts proof of delivery to the audit log. A missed window escalates before the day-of, not after.
Proposed operating behavior, not a live deployment. Source access, implementation and operator acceptance must be established before this workflow can operate in a community.
On the shift (illustrative)
Illustrative example on synthetic data. Names, figures, and events are not from any operator community.
A short-stay Medicare resident is two days from her projected end-of-coverage date. The system schedules the NOMNC delivery for today; the social worker walks into the room with the form on a tablet, explains the notice, and captures the signature. Proof of delivery posts to the audit log. The resident appeals; the operator can produce timely NOMNC delivery in seconds. If the resident or family had refused to sign, the workflow would have captured the refusal and the witness — same defensibility.
Design target
Late-NOMNC liability events go to zero. Medicare appeals that previously fell to the operator for procedural reasons are now defensible because the delivery proof exists.
Design target only: not measured or validated in any community. Actual results require an operator baseline and pilot acceptance.
What goes wrong without it
On the paper workflow, the NOMNC is a form the social worker hopes the family signed at some point. Sometimes it gets signed late. Sometimes it gets signed by the wrong person. When the resident appeals and the QIO asks for delivery proof, the operator cannot produce it — and the days the resident stays post-NOMNC become the operator’s liability rather than Medicare’s.
Sources for baselines cited above
Industry benchmarks referenced in the problem statement or outcome come from these third parties. SeniorCRE figures are labeled with their evidence class — modeled from workflow design and benchmarks, not yet measured in a customer community.
- CMS — Notice of Medicare Non-Coverage (NOMNC) and Advance Beneficiary Notice (ABN)
Centers for Medicare & Medicaid Services
Show me the evidence
Operators do not buy claims. They buy proof. If anything on this page reads as aspirational, ask us to walk you through exactly what is built, what is designed, and what is not yet in production in any community.
Where this connects in the platform
Every admissions workflow runs on the same record. These are the feature pages, head-to-head comparisons, and pillar articles that go deeper on the surfaces this workflow touches.
Feature surfaces
Compared head-to-head
Admissions and CRM references
Admissions workflows on this page reflect the Pre-Admission Screening and Resident Review (PASRR) requirements, HIPAA marketing rules for referral sources, and CMS hospital discharge planning Conditions of Participation.
- Hospital Discharge Planning Conditions of Participation — Final Rule
CMS / Federal Register
Sets the discharge planning timelines and the patient-choice requirements that drive referral channel design.
- PASRR — Preadmission Screening and Resident Review
Medicaid.gov
Federal screen required before Medicaid-funded SNF admission; gates the workflow for serious mental illness and intellectual disability.
- HIPAA Marketing Rule (45 CFR 164.508(a)(3))
eCFR
Governs how referral relationships, sponsorships, and patient outreach can be structured without violating authorization rules.
- F-622 — Transfer and Discharge Requirements
CMS
The interpretive guidance for resident-initiated and facility-initiated discharges that bookend the admissions lifecycle.