In an effort to focus on beneficiaries' rights, the Center for Medicare and Medicaid Services (CMS) has made changes to their beneficiary rights document known as An Important Message from Medicare. This document shares with beneficiaries their rights if they have concerns with their discharge and how to seek a second opinion by a Medicare Quality Review Organization (Quality Insights of Pennsylvania).
Beneficiaries have the right to ask questions and appeal decision about Medicare services. This is true whether the beneficiary is a member of the Original Medicare Plan or a Medicare managed care plan.
On November 27, 2006, the Centers for Medicare and Medicaid Services (CMS) published what they call a final rule, titled CMS-4105-F: Notification of Hospital Discharge Appeal Rights (PDF) to help patients clarify their rights regarding discharge. Beginning July 1, 2007, hospitals are required to deliver a revised version of the Important Message from Medicare. The Important Message from Medicare is the document that helps patients understand what they can do if they have concerns regarding their discharge.
At Mount Nittany Medical Center, patients with Medicare coverage will receive the notification in a two-step process for most patients beginning at admissions or before admissions if the patient is having elective surgery. Patients or patient representatives will be asked to read and sign the notice to ensure they understand what steps they can take if they have concerns regarding their discharge. The original signed form will be given back to the patient for reference and a carbon copy filed in the patient record.
A second notice is then presented to the patient again by the care manager at Mount Nittany Medical Center about two days before the scheduled discharge. This second notice has the same information as the first. A second notice further ensures that the patient is again provided their rights.
Medicare beneficiaries who are hospital inpatients have a right to appeal their discharge to an organization called the Quality Improvement Organization (QIO). If the patient chooses to appeal the physician and hospital's decision to discharge, the QIO will review the appeal from the patient to determine if the patient is okay to be discharged.
By providing two Important Message from Medicare notices, beneficiaries and/or their loved ones have the opportunity to ask questions and clarify information regarding the right to appeal the discharge. The staff at the Medical Center is available to answer questions regarding discharge throughout the stay of the patient. This two-step notification process further ensures that patients have the information to appeal before the day of discharge. If you or a loved one is a patient and a beneficiary of Medicare or Medicare Advantage, ask our staff to help you if you have questions regarding your benefits. The staff of the Social Services/Utilization Management Department at the Medical Center is available to answer questions and provide resources to all patients in our care.
Jamie Morrison is director of the social services/utilization management department at Mount Nittany Medical Center.