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
