Termination of Service

You have guaranteed rights and protections as a person with Medicare, including those with a Medicare Advantage Plan. If you are receiving care from a comprehensive outpatient rehabilitation facility, home health agency, hospice, or skilled nursing facility, and you are told care is no longer needed and will no longer be covered by Medicare, you will receive an advance notice called “Notice of Medicare Provider Non-Coverage” at least two days or visits before the services being provided are to end.

Once you receive a written notice, you can request an appeal review if you think you still need care and that Medicare should continue to pay for it. Call CCME’s Beneficiary Appeals Helpline in North Carolina at 866-885-4902 and in South Carolina at 800-922-3089, immediately—before your coverage ends. When you call, you should have a sheet called “Notice of Medicare Provider Non-Coverage” in hand.

When you ask for another opinion, CCME will review your case to determine if Medicare will continue to pay for your care. CCME will ask the provider to write a Detailed Notice of Discharge. The provider will supply CCME and you a copy of the notice and your records.

• If CCME agrees with the provider’s decision
  You will be responsible for paying the provider charges beginning noon of the day after CCME gives you its decision. You are not responsible for payment during the review process if you request the review in a timely manner.

• If CCME agrees with you
  Medicare will continue to cover services as long as they are medically necessary.

If you get a “Notice of Medicare Provider Non-Coverage” and would like CCME to review your case, contact us at 866-885-4902 in North Carolina and 800-922-3089 in South Carolina. You may also call Medicare at 1-800-MEDICARE
(1-800-633-4227), TTY/TTD 1-877-486-2048, or visit Medicare’s website.