What is a Hinn in a hospital?
Issued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case. There are currently four different HINNs. Informs beneficiaries of their discharge when their Medicare covered services are ending.
What are the different types of hinns?
There are currently four different HINNs. Informs beneficiaries of their discharge when their Medicare covered services are ending. Given only if a beneficiary requests an expedited determination. Explains the specific reasons for the end of covered services. Informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights.
What happens if a hospital doesn't give you a Hinn?
If hospitals don't give patients a HINN when inpatient services aren't covered by Medicare, the hospital cannot bill the patient for the services later on, according to Deborah Hale, CCS, CCDS, president and chief executive officer of Administrative Consultant Service, a healthcare consulting firm based in Shawnee, OK.
What is a 44 Hinn?
When Condition Code 44 is used to change the patient's status from inpatient to outpatient, the hospital can collect payment from Medicare for Part B services, she adds. Before Medicare began requiring hospitals to give patients the Important Message from Medicare (IM), notifying them of their right to appeal their discharge, there were 12 HINNs.
What is the purpose of the Moon letter?
The MOON is a standardized notice to inform beneficiaries (including Medicare health plan enrollees) that they are an outpatient receiving observation services and are not an inpatient of the hospital or CAH.
What is IMM in case management?
DEFINITION: IMPORTANT MESSAGE FROM MEDICARE (IM or IMM): A hospital inpatient admission notice given to all beneficiaries with Medicare, Medicare and Medicaid (dual-eligible), Medicare and another insurance program, Medicare as a secondary payer.
What is a detailed notice of discharge?
A Detailed Notice of Discharge is a notice given to you by a hospital after you have requested a Quality Improvement Organization (QIO) review of the hospital's decision that you be discharged.
What does code 44 mean in a hospital?
A Condition Code 44 is a billing code used when it is determined that a traditional Medicare patient does not meet medical necessity for an inpatient admission.
When should the IMM be given?
Hospitals must issue the IM within two calendar days of admission, obtain the signature of the beneficiary or their representative and provide a copy at that time. Hospitals will also deliver a copy of the signed notice as far in advance of discharge as possible but not more than two calendar days before discharge.
Who gets an IMM?
CMS has defined how this “Important Message from Medicare” (IM) is to be delivered by hospitals to Medicare beneficiaries: The IM is a standard notice that must delivered to all Medicare inpatients within two days of admission and no more than two calendar days before discharge.
Can Medicare kick you out of the hospital?
Medicare covers 90 days of hospitalization per illness (plus a 60-day "lifetime reserve"). However, if you are admitted to a hospital as a Medicare patient, the hospital may try to discharge you before you are ready. While the hospital can't force you to leave, it can begin charging you for services.
What is the criteria for patient discharge?
Results: Experts reached consensus that patients should be considered ready for hospital discharge when there is tolerance of oral intake, recovery of lower gastrointestinal function, adequate pain control with oral analgesia, ability to mobilize and self-care, and no evidence of complications or untreated medical ...
What does a discharge plan include?
Your discharge plan should include information about where you will be discharged to, the types of care you need, and who will provide that care. It should be written in simple language and include a complete list of your medications with dosages and usage information.
Is Condition 44 only for Medicare?
Hospitals use condition code 44 and condition code W2 to bill for Medicare Part B payment in cases where the attending physician orders an inpatient stay that does not meet Medicare's requirements for Part A payment.
What is the 2 midnight rule?
The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.
What does condition code 42 mean?
• Condition Code 42 - used if a patient is discharged to home with HH services, but the continuing care is not related to the condition or diagnosis for which the individual received inpatient hospital services.
When do hospitals need to provide HINNS?
CMS requires hospitals to provide HINNs to patients before admission, at admission, or at any time during an inpatient stay if the hospital determines that the care the patient is receiving or is about to receive is not covered because it is not medically necessary, not delivered in an appropriate setting, or is custodial in nature.
What is a HINN?
Here's a look at the HINNs and when to use them: The Preadmission/Admission HINN, also known as HINN 1, notifies patients that Medicare is not likely to pay for the admission because it is not likely to be considered medically necessary or can safely occur in another setting.
Why is a hospital not covered by Medicare?
When hospitals determine that the care patients are receiving or are about to receive will not be covered by Medicare because it is not medically necessary, not delivered in an appropriate setting, or is custodial in nature, the hospital should provide the patient with a Hospital-Issued Notice of Noncoverage (HINN) to inform them that they will be responsible for the bill if they choose to stay in the hospital.
What should a HINN inform patients?
The HINN should inform patients that they may ask the Quality Improvement Organization (QIO) to review the HINN 1. Case managers must get patients to sign the HINN, indicating that they received it, and put a copy in their files.
What is condition code 44?
CMS also provides hospitals with the option of using Condition Code 44 for correcting an unnecessary admission, but the physician responsible for the care of the patient must agree that the inpatient admission was unnecessary and the patient must be notified in writing before discharge," she says. When Condition Code 44 is used to change ...
When should a preadmission/admission HINN be delivered?
The preadmission/admission HINN should be delivered when a physician wants to admit a patient who will not meet admission criteria or has already admitted a patient and the hospital determines that he or she never met admission criteria, Sallee says. Examples include social admissions when patients don't meet criteria but ...
Can a hospital bill a patient for a HINN?
If hospitals don't give patients a HINN when inpatient services aren't covered by Medicare, the hospital cannot bill the patient for the services later on, according to Deborah Hale, CCS, CCDS, president and chief executive officer of Administrative Consultant Service, a healthcare consulting firm based in Shawnee, OK.
What does HINN mean in Medicare?
What do you do when a Medicare patient is medically able to be discharged, but refuses? The Medicare Hospital Initiated Notice of Non-Coverage (HINN) is a powerful tool for hospital staff in dealing with patients who are not cooperating with their discharge plan.
Can a hospital use a HINN?
According to the Baltimore-based Health Care Financing Administration's PRO manual, if a hospital is able to determine in advance that the beneficiary will not require acute inpatient hospital care as of a certain date, it may give the notice of non-coverage in advance of that date -- but ordinarily no earlier than ten days before the first non-covered day.
Why is a HINN issued?
A HINN is issued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case.
What is HINNS in hospital?
Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay if the hospital determines that the items or services the beneficiary is receiving, or is about to receive, are not covered because it is: Custodial in nature.
What does Medicare require hospitals to do?
The Centers for Medicare & Medicaid Services requires hospitals to give patients an array of documents to explain their rights, their status, and any financial obligations they may incur — and it’s usually up to case managers to see that the hospital complies.
What is MOON in Medicare?
The Medicare Outpatient Observation Notice (MOON) is the latest requirement, but the Important Message (IM) from Medicare also is required under the Medicare Conditions of Participation. In order to bill patients for services that are incurred but not covered, hospitals also must give patients a Hospital Issued Notice of Noncoverage (HINN).
What happens if a hospital delivers documents at the proper time?
If the documents are delivered at the proper time, they could affect the hospital’s reimbursement, increase the risk of audit, and affect patients’ understanding of their rights and responsibilities. The entire treatment team should be aware of the documents and intentions.
Can a hospital be audited by CMS?
If hospitals are not accredited, CMS may audit them for compliance,” she adds. Annala-Rogers recommends that hospitals take a proactive approach and conduct their own audits of patient records to make sure that the appropriate patients are given the appropriate notices and documented in the medical record.
Is a hospital still struggling to comply with CMS?
Hospitals are still struggling as to what processes to use so they are compliant with CMS requirements, Annala-Rogers says. “Delivering the notices to patients takes a concerted effort between case management, the ordering physicians, and the admitting/registration department.
What is HINN 10?
HINN 10, also called the Notice of Hospital Requested Review, should be given to patients when the hospital requests a review from the Quality Improvement Organization because the attending physician does not agree with the hospital’s decision to discharge the patient.
What does HINN 11 mean?
HINN 12 notifies patients of their potential financial liability if they continue to stay when they no longer meet criteria for an inpatient level of care.
What is BNI in Medicare?
Beneficiary Notices Initiative (BNI) Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries ...
Why is SNF not paid for?
Issued in order to transfer financial liability to beneficiaries before the SNF provides an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or is custodial in nature.
What is Medicare Part B?
Issued in order to transfer financial liability to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case.
What is a hospital notice of observation services?
Hospital or MA Plan. Issued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).
Why The Reluctance?
- Not wanting to get involved in such sticky issues, physicians and hospital staff count on the URcoordinators to issue the notice and deal with the consequences. If handled properly, they can useHINN without offending physicians and without alienating patients too much. Kennedy explains howto overcome reluctance to use the HINN, when to use it, and ...
Who Is A Candidate For Hinn?
- Patients and their families have all sorts of reasons for not wanting to cooperate with the dischargeplan. They may simply say the patient does not feel well enough or strong enough. They may beafraid. They may be unwilling to transfer to a nursing home. The patient's family may not be helpful inlocating a nursing home. They may say that they have not found just the right home …
Eliminating The Two-Day Grace Period
- If a utilization management professional becomes convinced that using the HINN can save the hospitalmoney, he or she may want to go a step further and use the Advanced Continued Stay HINN.According to the Baltimore-based Health Care Financing Administration's PRO manual, if a hospitalis able to determine in advance that the beneficiary will not require acute inpatient hospi…