keyglobeiollogoPhone (319) 626-2302

Catalog Number : ngd1387
Title : CMS Medicare Discharge Appeal Right
Speaker : Sue Dill

Duration : 120 minutes

Webplay Recording Date : 6-14-2007
Webplay Price : $ 225 for two weeks viewing

Teleconference/Webinar Presenter: Sue Dill Calloway, RN, Esq., AD, BA, BSN, MSN, JD

Teleconference/Webinar Title: Notification of Hospital Discharge Appeal Rights

Teleconference/Webinar Level: Intermediate

Teleconference/Webinar Description:

The Centers for Medicare & Medicaid Services (CMS) issued a final rule, called “Notification of Hospital Discharge Appeal Rights” on November 27, 2006, (CMS-4105-F). This final rule responds to the many comments (about 500) received on a proposed rule that was published in the Federal Register on April 5, 2006. The new law becomes effective on July 1, 2007. The proposed rule set forth requirements for how hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Notice is required for both original Medicare beneficiaries and for beneficiaries enrolled in Medicare health plans. This program will address the new regulation in detail and strategies to ensure compliance.

Teleconference/Webinar Objectives:

  • Recall new regulations that every hospital must follow when Medicare patients are admitted including the new IM form that must be given to the patient and signed on admission
  • Describe the new process that must be followed before a Medicare patient is discharged from the hospital including the requirement to give a signed copy of the IM form within two days of discharge
  • Discuss the new process of when the QIO will be involved in reviewing cases involving discharges of Medicare patients.

Teleconference/Webinar Outline:

  • Notice that has to be given to patients on admission
  • Requirements of the process
  • Right of the patient to request expedited review
  • Process for requesting an expedited review
  • Burden of proof if patient thinks being discharged prematurely
  • Hospital responsibility in expedited review process
  • Responsibly for bill during review process
  • Process when hospital requests Quality Improvement Organization (QIO) to review case because physician thinks patient should not be discharged
  • Process for expedited review before hospital could charge Medicare patient for a continued stay
  • New definition of discharge
  • Patient to receive copy of new and revised standardized form when Medicare patient is admitted
  • When hospital has to give patient copy of signed notice and timeframe before discharge
  • Patient’s rights to request expedited review
  • Process for requesting immediate review
  • When a patient must submit a request to the QIO to have case reviewed
  • Burden of proof is with the Medicare Advantage Organization (MAO) to demonstrate that discharge decision is correct
  • Responsibilities of the MAO and hospital in immediate review process
  • Who is responsible for bill when patient requests reconsideration

Prerequisites: None

Target Audience: CFO, CNO, Billing Director, Director of Registration, Utilization Review Staff, Discharge Planners, Physicians, VP of Medical Staff, Billing Office Staff, Compliance Officer, Medical Staff Coordinator, Risk Manager, Patient Safety Officer, Senior Leadership, Legal Counsel, PI Director, The Joint Comission Coordinator, Nurse Managers, Director of Health Information Management, Director of Anesthesia and OR Director

Nursing Contact Hours: This course has been approved for 2.4 Iowa Nursing Contact Hours. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Refund Policy:

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.