Case Management

CMW Tip of the Week: Clarifying delivery of the IM

Case Management Weekly, December 3, 2008

Last week’s tip on delivering the Important Message (IM) from Medicare prompted some follow-up questions about the required timing for delivery of the IM. This week, two new experts offer insight on best practices for delivering the IM.

Jackie Birmingham, RN, BSN, MS, CMAC, author of Discharge Planning Guide: Tools for Compliance says:
Instead of having a process in place where the IM is delivered to all Medicare beneficiaries every Monday, Wednesday, and Friday, case managers should spend that time working with patients and determining which patients are expected to be discharged within the next two days, and thus are eligible to receive follow-up IMs. Patients should receive follow-up IMs as soon as possible, but no more than two days prior to discharge. If a patient receives the initial IM within two days of discharge, no follow-up is necessary.
Giving the IM routinely (i.e., designating Mondays, Wednesdays, and Fridays as issuing days) obscures the intent of CMS’ rule. According to CMS, the purpose of providing patients with a follow-up copy of the IM is to ensure that beneficiaries are aware of their rights at the time when they may need to exercise them. If patients receive an IM on Monday, Wednesday, and Friday during their hospital stay as a matter of routine, they will have no idea which day they are going to be discharged.
For some patients, discharge cannot be predicted before the day of discharge. In these rare cases, the IM may be delivered on the day of discharge and the patient can have up to four hours to decide whether to appeal, although discharge need not be delayed if the patient clearly consents. CMS prohibits any facility from having a policy in place where IMs are routinely delivered on the day of discharge.
Wendy DeVreugd, RN, BSN, PHN, FNP, senior director of case management for the West Group of Kindred Healthcare, Hospital Division, in Westminster, CA, says:

Our process is designed as follows:

  • Admissions staff deliver the initial IM letter, explain it to patients, and have patients sign it during the admission process
  • The IM is placed in the patient’s chart and a copy is placed in the case management (CM) box
  • The CM director picks up the copies of the IM and gives them to the accountable case manager
  • During the week, if discharge is ordered, the case manager delivers the follow-up IM letter, explains it to the patient, answers questions, and gets it signed
  • On the weekend, the house supervisors are accountable for getting the letter signed

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at thoughts could be featured in the next issue of Case Management Weekly!


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