Source: https://staging.medicareadvocacy.org/medicare-topics/all-other-topics/discharge-planning/
Timestamp: 2018-05-26 02:18:29
Document Index: 517173999

Matched Legal Cases: ['§422', '§3630', '§50', '§409', '§424', '§1834', '§424', '§418', '§418', '§418']

Discharge Planning | The Center for Medicare Advocacy
Discharge Planning Summary
General Guidelines & Cautions
Informational Tools for Caregivers
Become familiar with discharge planning and its interplay with “transitions,” an activity that includes the preparing for and moving from one care setting to another. See “Breathing Life into Discharge Planning” by Alfred J. Chiplin, Jr. (site visited May 15, 2015).
Effective July 1, 2007, Medicare participating hospitals must deliver valid, written notice, using the “Important Message from Medicare” (IM) (site visited May 15, 2015). This notice is to explain a patient’s rights as a hospital patient including discharge appeal rights. It is to be given at or near admission, but no longer than 2 calendar days following the beneficiary’s admission to the hospital. See 42 CFR 405.1205 (Traditional Medicare) and 42 CFR §422.620 (Medicare Advantage).
The “Important Message from Medicare”, Form CMS-R-193, and the “Detailed Notice of Discharge”, Form CMS-10066, updated as of July 20, 2010 are posted on the Centers for Medicare & Medicaid Services (CMS) website: http://www.cms.gov/Medicare/Medicare-General-Information/BNI/HospitalDischargeAppealNotices.html. (Site visited May 18, 2015.) The latest version of the “Important Message from Medicare” requires hospitals to note the time of delivery. Note, after April 1, 2011, the notice of discharge forms with approval dates of 05/07 will not be valid.
In order for the review request to be considered “timely,” beneficiaries must submit their requests in writing or by telephone no later than midnight of the day of discharge and before they leave the hospital. The beneficiary, therefore, should not be discharged upon requesting the QIO review, so long as the request is made on the same day.
The Detailed Notice of Discharge must be delivered “as soon as possible” after the beneficiary has requested a QIO review, but no later than noon of the day after the QIO notifies the hospital of the beneficiary’s request for the review. Under the CMS guidelines, hospitals are only required to deliver the Detailed Notice after the beneficiary has contacted the QIO for expedited review or when the beneficiary requests more detailed information from the medical care provider prior to requesting a QIO review. The Detailed Notice is not an official Medicare decision. It is designed to give the patient further explanation about why the hospital and/or physician believe that the medical services are no longer necessary.
What Information Must the Important Message from Medicare (“IM”) Contain?
When must the “IM” be Distributed?
The patient must receive the original IM within two days of admittance to the hospital. The hospital must obtain the signature of the beneficiary or of his or her representative and provide a copy to that person at that time. If the patient or representative refuses to sign the IM, then the hospital is required to make a note to that effect; for purposes of requesting an appeal, the date of the refusal to sign is considered the date of notification. A follow-up copy of the signed IM should again be given “as far in advance of the discharge as possible, but not more than 2 calendar days before discharge.” If discharge occurs within 2 days of the date the IM was given, no follow-up copy is required.
The notice, “An Important Message from Medicare about Your Rights” (IM), can be found on the CMS website at http://www.cms.gov/BNI/12_HospitalDischargeAppealNotices.asp (site visited May 15, 2015). The requirements for the new notice are discussed in Guidelines which were released by the Centers for Medicare & Medicaid Services (CMS) on May 25, 2007. In the Guidance, CMS explains when and how Medicare patients must be given information about their discharge and appeal rights. See, http://www.cms.gov/Transmittals/downloads/R1257CP.pdf (site visited May 15, 2015).
If the beneficiary does not agree with the facility’s non-coverage decision, he or she may request that the SNF submit the bill to Medicare even when the facility believes that services will not be covered by Medicare. This submission is called a “demand bill” or a “no-payment bill.” Demand bills are required to be submitted at the request of the beneficiary. The facility cannot bill the beneficiary for the disputed charges until the Medicare fiscal intermediary issues a formal claim determination (Medicare Intermediary Manual §3630; Sarrassat v. Sullivan, Medicare and Medicaid Guide (CCH), ¶38,504 (N.D. Cal. 1989)).
We are experiencing an up-tick in termination of services of severely ill patients who need chronic, on-going care. Often, these patients are expensive to treat. HHAs express concern about the cost of these cases and about their patient mix. Many are terminating services for “business reasons.” This will be an on-going area of advocacy.
Medicare beneficiaries are entitled to an explanation of the circumstances in which a beneficiary has the right to have a “demand bill” submitted. (CMS online manual system, Pub. 100-4, Medicare Claims Processing, www.cms.gov/manuals, Chapter 30, §50)—site visited May 18, 2015.
The regulations establish that a face-to-face encounter must have “occurred no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care by including the date of the encounter.” In addition, the certification of the need for home health care must include an explanation as to why the physician’s clinical findings support the need for home health care, including that the patient is homebound and the need for either intermittent skilled nursing services or therapy services as defined in 42 C.F.R. §409.42(a) and (c). See 42 C.F.R. §424.22(a)(1)(v). Regulations also provide that a face-to-face encounter can be by tele-health as provided in §1834(m) of the Social Security Act. See 42 C.F.R. §424.22(a)(1)(C).
There are no specific appeal rights when a discharge is for cause, although the beneficiary must be notified by the hospice when discharge for cause is being considered.” 42 C.F.R. §418.26(a). The hospice is, however, to:
The required narrative of certification must include a statement, written directly above the physician’s signature, attesting that the physician confirms that the narrative is based on his or her examination of the patient. 42 C.F.R. §418.22(b)(3)(iii). In addition, the narrative for the 3rd benefit period and each subsequent benefit period must explain why the clinical findings of the face-to-face encounter support a life expectancy of 6 months or less. 42 C.F.R. §418.22(b)(3)(v).
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Medicare Discharge Planning: Think Through Your Needs Dec 21, 2009