Important Message from Medicare: Are You Following All the Rules?
The Centers for Medicare and Medicaid Services (CMS) requires that all Medicare inpatients receive written information about their hospital discharge appeal rights.
A-0117 (Rev. 75, Issued: 12-02-11, Effective: 12-02-11, Implementation: 12-02-11) §482.13(a)(1) A hospital must inform each patient, or when appropriate, the patient’s representative (as allowed under State law), of the patient’s rights, in advance of furnishing or discontinuing patient care whenever possible
CMS has defined how this “Important Message from Medicare” (IM) is to be delivered by hospitals to Medicare beneficiaries:
- The IM is a standard notice that must delivered to all Medicare inpatients within two days of admission and no more than two calendar days before discharge.
- The IM form is an Office of Management and Budget (OMB) approved form and the content cannot be altered from its original form. The OMB control number must appear on the notice.
- The time frame for the delivery of the form is clearly spelled out in the Conditions of Participation (CoPs) 482.13(a)(1),as illustrated in this table.
- The IM is to be signed and dated by the beneficiary (patient or appointed representative) to acknowledge receipt.
- The department responsible for delivering the form is determined by the hospital and is usually performed by Registration, Case Management, Social Work, or Nursing.
It is important to remember that CMS requires 100% compliance, so organizations should hard-wire the process.
Hard-Wiring the Process for Compliance
The first step in hard-wiring the process is to create and implement policies and procedures that define how the notification process will occur during every hospital day. Instructions are included in Chapter 30 of the Medicare Claims Processing Manual.
To ensure compliance, we encourage you to review the instructions in the CMS Claims Manual regarding how and when to deliver the IM and steps to take when the beneficiary (patient or appointed representative) requests a QIO review.
You will also need to audit your performance. Most hospitals audit for compliance in their monthly closed medical record review, which enables the organization to monitor the timeliness of delivery of both the IM admission and IM discharge forms.
Assessing Compliance with the IM Requirements
To assess your compliance with these requirements, your organization should consider the following questions:
- What is your hospital’s policy for notifying Medicare beneficiaries (patients or appointed representatives) of the patients’ rights to appeal a discharge decision?
- What is your hospital’s policy when a patient is incapacitated or has an appointed representative who must be informed of the discharge appeal rights and process?
- Does your hospital have alternative means, when necessary, for communicating patients’ rights when English is not the beneficiaries’ primary language?
- Do staff members know what steps to take if the beneficiary requests a QIO review?
Timeliness of IM Delivery
To ensure timeliness of IM delivery, review inpatient medical records for Medicare beneficiaries to determine whether the records contain a signed and dated IM provided within two days of the patient’s admission.
If a patient’s discharge occurs more than two days after the initial Important Message from Medicare was issued, another copy of the IM must be provided to the patient not more than two calendar days before the patient’s discharge. As described in the State Operations Manual, “In the case of short inpatient stays, however, where initial delivery of the IM is within [two] calendar days of the discharge, the second delivery of the IM is not required.”
While most hospitals have achieved compliance with delivery of the form on or before admission, many struggle with compliance in delivering the form at discharge. However, delivery of this notice must be documented per CMS requirements.
The latest versions of the IM (Form CMS-R-193), and the “Detailed Notice of Discharge,” (Form CMS-10066), along with instructions, are posted on the CMS website. This version of the IM requires hospitals to note the time of delivery.
If you have any questions, you can contact your FI or A/B MAC at their toll-free number, which may be found on the CMS website.
For more information on compliance with the CMS Conditions of Participation surrounding the Important Message from Medicare, contact TiER1 Healthcare.
- Medicare Claims Processing Manual Chapter 30 – Financial Liability Protections
- Expedited Determinations for Provider Service Terminations
- CMS Provides ACMA with FAQ Document Addressing Case Managers’ Concerns Surrounding the Important Message from Medicare (IM) Second Notice