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Important Message delivery

Patient Access Weekly Advisor, June 18, 2008

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Patient financial liability is not the only concern requiring inpatient notification. As a patient access manager, you also must educate your staff on the notices related to discharge appeal rights.

The details of that process, including the rights and responsibilities of hospitals and Medicare patients, are set out in the Medicare Claims Processing Manual, Chapter 3, Section 200 onward. The following provides a brief overview of the delivery of Medicare’s Important Message:

Under the revised process, hospitals are required to inform Medicare patients initially of their discharge appeal rights through provision of the standard IM form within two days of admission, with follow-up notice not more than two days, but not less than four hours, before discharge. Those rights include the right to seek review of the hospital’s discharge decision by the QIO, an organization separately contracted by Medicare to provide review of admission and discharge decisions.

If the patient seeks timely review (by midnight on the date of the proposed discharge) and remains in the hospital after midnight, the beneficiary’s liability for services provided after the date of the proposed discharge will be limited to applicable deductibles and coinsurance until noon of the day following notification of the QIO’s agreement with the hospital. Upon a request for timely review, the QIO has one day following receipt of all relevant information from the patient and hospital in which to make a determination. If the patient fails to seek timely review, he or she may still seek review at any time during that stay or within 30 days of discharge. If the patient seeks review while remaining in the hospital, the QIO must make its determination within two days of receipt of all relevant information.

If the request occurs after the patient’s discharge, the QIO has 30 days from the receipt of all relevant information to make its decision. In either case, it appears that the patient will be liable for all care provided after the date of the proposed discharge, unless the QIO determines otherwise.

Provided by Judith L. Kares, JD, CPC

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