Hospital discharge appeal notices
New Important Message from Medicare notice and process replaces continued-stay HINN and NODMAR notice processes, beginning July 2, 2007
Beginning July 2, 2007, Oregon hospitals must follow a revised process for notifying Medicare beneficiaries (including fee-for-service beneficiaries as well as /Medicare Advantage enrollees) or their legal representatives of the right to appeal the hospital's discharge decision based on medical necessity. Acumentra Health, as Oregon's Medicare Quality Improvement Organization (QIO), conducts discharge reviews when requested by beneficiaries.
- Within 2 days of admission, hospitals must deliver a revised version of the Important Message from Medicare (IM; CMS-R-193) to inform Medicare beneficiaries who are hospital inpatients about their discharge appeal rights. Use of the IM is required both for Original Medicare beneficiaries and for Medicare Advantage enrollees.
- If a beneficiary decides to appeal a discharge decision, Acumentra Health will notify the hospital, which must then deliver a Detailed Notice of Discharge (CMS 10066) to the beneficiary and provide information requested by Acumentra Health.
The new notice processes replace previous Notice of Discharge and Medicare Appeal Rights (NODMAR) processes for Medicare Advantage health plan members and continued-stay Hospital-Issued Notice of Noncoverage (HINN) processes for beneficiaries with Original (fee-for-service) Medicare.
The new notices
IM—initial copy
In contrast to the previous single-page Important Message from Medicare, the new IM is a 2-page notice that requires the beneficiary's signature (or documentation of refusal to sign). It is to be given to the beneficiary within 2 days of admission.
IM—follow-up copy
The hospital is required to give the beneficiary a follow-up copy of the initial IM prior to discharge—as far in advance as possible, but no more than 2 calendar days before the discharge date.
- If delivery on the discharge date is unavoidable, the hospital must allow at least 4 hours for the beneficiary to consider his or her appeal rights. A hospital may not make a procedure to routinely deliver the follow-up notice on the discharge date.
- If delivery of the original IM is within 2 calendar days of the discharge date, no follow-up notice is required.
- The hospital must document delivery to the beneficiary.
Detailed Notice of Discharge
IIf the beneficiary asks Acumentra Health to review the discharge, the hospital must deliver a Detailed Notice of Discharge to the beneficiary, using a new standardized form.
Where to get the notices
Acumentra Health has sent copies of the two notices to each Oregon hospital that is required to use them, along with Acumentra Health telephone numbers. Contact us if you need to have the file redelivered.
Blank notices in English and Spanish are also available on the CMS website at www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp
Beneficiary appeal rights
Medicare beneficiaries and their legal representatives have a federal right to dispute a hospital's discharge decision by requesting a review from Acumentra Health. The purpose of this review is to ensure that the IM notice and Detailed Notice are correct and that beneficiaries’ services are not terminated prematurely. A board-certified or board-eligible physician makes the review determinations.
The hospital must send medical records and Acumentra Health must complete its review and issue a decision by one day after receiving all necessary information. Medicare continues to pay for the beneficiary’s care during the review, provided that the beneficiary appealed in a timely manner (i.e., by midnight of the day of discharge).
Resources from CMS
Visit the Hospital Discharge Appeal Notices page on the CMS website for detailed information and current forms.
Contact
For more information use our contact form.