Hospital discharge appeal notices

Hospitals must follow a 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 who are receiving care from Oregon providers.

  • 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.

As of July 2007, these 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. Some other types of HINNs remain in effect.

The new notices

IM—initial copy

The 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

If a beneficiary asks Acumentra Health to review a discharge from a provider, the hospital must deliver a Detailed Notice of Discharge to the beneficiary, using a new standardized form.

Where to get the notices

Blank notices in English and Spanish are 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 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.

Last updated August 17, 2011