Revenue Cycle

CMS says readmissions pilot program is working

Patient Access Weekly Advisor, December 30, 2009

The following article is an excerpt from HCPro’s resource for hospital case managers—www.CaseManagementMentor.com—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.

The American Case Management Association (ACMA) Public Policy Committee surveyed nearly 400 case management professionals regarding the second notice of the Important Message (IM) from Medicare.

The IM informs patients of their discharge appeal rights. CMS refers to the second IM as the “follow-up copy”. Hospitals must deliver it more than two calendar days before discharge and at least four hours before discharge. Hospitals issue the first IM seven calendar days before admission, or up to two days after admission.

The findings were as follows:

  • The majority of respondents (84%) report that case management is responsible for issuing the second IM
  • More than half the respondents (59%) report that 10 minutes or less are required to issue each IM
  • More than 77% of respondents report that they track IM compliance
    • Of those who track IM compliance, 40% report a compliance rate between 76% and 100%
  • Only 38% of respondents report increased numbers of appeals
  • The majority report that less than 25% of patient appeals are successful

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