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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.
Additional information and copies of the the various notices to be issued can be found at the Centers for Medicare & Medicaid (CMS) Beneficiary Discharge Notices Page or at the CMS Beneficiary Initiative Page. |
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All information on this site is provided as a public service only and should not be relied upon as medical or legal advice. Some of the information included in this site was obtained through work performed under a contract with the Centers for Medicare & Medicaid Services, Department of Health and Human Services. SDFMC shall not be held liable for any damages arising from the use of or reliance upon information supplied herein. Any links to other organizations contained on this site are for informational purposes only and do not imply endorsement by SDFMC.
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