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Medicare beneficiaries and Medicare Advantage (MA) plan enrollees who are hospital inpatients have a statutory right to appeal to a Medicare Quality Improvement Organization (QIO) for an expedited review of a discharge decision.

Hospitals must notify Medicare beneficiaries and MA enrollees who are hospital inpatients about their rights as a hospital patient, including discharge appeal and general liability rights. Hospitals will use a revised version of the Important Message from Medicare (MA), a statutorily required notice, to explain these rights.

The Benefits Improvement and Protection Act (BIPA) of 2000 gave Medicare beneficiaries the right to appeal a provider’s decision to terminate services in certain care settings. Providers are required to issue a Notice of Medicare Provider Non-Coverage to a beneficiary prior to termination of their Medicare covered service in order to be in compliance with the new regulation. The regulation applies to beneficiaries with traditional Medicare (fee-for-service) coverage in comprehensive outpatient rehabilitation facilities (CORFs), home health agencies (HHAs), hospice care, swing beds and skilled nursing facilities (SNFs). A similar appeals process, known as a fast-track appeal, began in January 2004. It exists for CORF, HHA and SNF/swing bed patients enrolled in Medicare Advantage plans.

Benefits Improvement and Protection Act (BIPA)Notices
  • BIPA Generic Notice Instructions


  • BIPA Generic Notice Clean-OMB Approved for use thru 7/31/2011


  • BIPA Detailed Notice Instructions


  • BIPA Detailed notice OMB Approved thru 7/31/2011


  • Powerpoint Presentation About BIPA


  • Federal Regulation 42 CFR 405 1200


  • Federal Regulation 42 CFR 405 1201



  • Hospital Important Message From Medicare and Discharge Notices
  • Important Message from Medicare Revised May 2007


  • Detailed Notice of Discharge Revised May 2007


  • Detailed Discharge Notice Instructions in Spanish Revised May 2007


  • Detailed Discharge Notice in Spanish Revised June 2007


  • SDFMC Medicare Mediation Activities
  • Mediation Program - One Page Summary


  • Physician Reviewer Mediation Guide


  • Physician Mediation Resource Packet -updated40103.pdf


  • Medicare Advantage (MA) Appeal Procedures
  • Procedure


  • Non-Physician Reviewer format and Physician Review Assessment Format (PRAF)


  • Notice of Medicare Non-Coverage Instructions(NOMNC Instructions.pdf)


  • Notice of Medicare Non-Coverage Form (CMS 10095 NONMNC-2007.doc)


  • Detailed Explanation of Non-Coverage Instructions(DENC Instructions)


  • Detailed Explanation of Non-Coverage Form (CMS 10095-DENC-2007.doc)





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