What are the CMS requirements for sending Hinn letters?
"CMS has very specific requirements about when each of the HINNs should be delivered and what the HINN letter should say. All of the HINNs must be signed by patients and a copy placed in their file," Sallee adds.
What is a Hinn and how is it 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. There are currently four different HINNs: HINN1, HINN10, HINN11, & HINN12. Who Must Report? How Do I Report?
What is a hospital-issued notice of non-coverage (Hinn)?
A Hospital-Issued notice of Non-Coverage (HINN) is a written notice which explains: That probably will not cover your hospital stay; What you will have to pay if you decide to go ahead with your care anyway; and Your rights to an immediate QIO of the hospital’s decision.
When does a patient become liable for a Hinn?
If it's delivered after 3 p.m., the patient becomes liable the following day, Sallee says. The HINN should inform patients that they may ask the Quality Improvement Organization (QIO) to review the HINN 1.
What is the Hinn used for?
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.
What Hinn 11?
HINN 11 is used for noncovered items or services provided during an otherwise covered stay. HINN 12 should be used in association with the Hospital Discharge Appeal Notices to inform beneficiaries of their potential financial liability for a noncovered continued stay.
What is a Medicare IMM letter?
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 is a 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. View the form.
When should you give an Important Message from Medicare?
An Important Message from Medicare is a notice you receive from the hospital and sign within two days of being admitted as an inpatient. This notice explains your rights as a patient, and you should receive another copy up to two days, and no later than four hours, before you are discharged.
What is an IMM?
IMM stands for the International Monetary Market. Interest Rate products that have an original maturity of less than 366 days, trade in what is commonly referred to as the “Money Market”. The IMM index is the pricing convention and the IMM date is the date of expiration for these products.
What is IMM and moon?
These include the Important Message from Medicare (IM), the Medical Outpatient Observation Notice (MOON), the Advance Beneficiary Notice of Noncoverage (ABN), the Emergency Medical Treatment & Labor Act (EMTALA) requirements, Medicare Secondary Payer (MSP) and Centers for Medicare & Medicaid Services (CMS) ...
What is a requirement of the Important Message from Medicare notification process?
Currently, at or about the time of admission, hospitals must deliver the “Important Message from Medicare” (IM), as required by Section 1866(a)(1)(M) of the Social Security Act (the Act), to all hospital inpatients with Medicare to explain their rights as a hospital in-patient, including their right to an expedited ...
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.
Why did I get a letter from CMS?
In general, CMS issues the demand letter directly to: The Medicare beneficiary when the beneficiary has obtained a settlement, judgment, award or other payment.
Who gets an IM letter?
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.
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 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 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.
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 ...
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.
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.
Do you have to sign a HINN if you refuse to sign?
All of the HINNs must be signed by patients and a copy placed in their file," Sallee adds. If someone refuses to sign a HINN, a copy should be placed in their files and a notation made of their refusal. Here's a look at the HINNs and when to use them: The Preadmission/Admission HINN, also known as HINN 1, notifies patients ...
How long is a Medicare extended treatment notice valid?
A single notice for an extended course of treatment is only valid for 1 year. If the extended course of treatment continues after 1 year, issue a new notice.
How long does it take for Medicare to refund a claim?
Medicare considers refunds timely within 30 days after you get the Remittance Advice from Medicare or within 15 days after a determination on an appeal if you or the beneficiary file an appeal.
When do you issue a reduction notice?
Reductions occur when a component of care decreases (for example, frequency or service duration). Do not issue the notice every time there is a reduction in care. If a reduction occurs and the beneficiary wants to continue getting care no longer considered medically reasonable and necessary, you must issue the notice before the beneficiary gets the noncovered care.
Is an ABN valid for Medicare?
An ABN is valid if beneficiaries understand the meaning of the notice. Where an exception applies, beneficiaries have no financial liability to a non-contract supplier furnishing an item included in the Competitive Bidding Program unless they sign an ABN indicating Medicare will not pay for the item because they got it from a non-contract supplier and they agree to accept financial liability.
Does Medicare cover frequency limits?
Some Medicare-covered services have frequency limits. Medicare only pays for a certain quantity of a specific item or service in each period for a diagnosis. If you believe an item or service may exceed frequency limits, issue the notice before furnishing the item or service to the beneficiary.
What is a HIN 12?
A. The HINN 12 is the denial notice most familiar to those who work in case management. This notice, also known as the Continued Stay HINN, is given at the end of a hospital stay when a discharge order is given but the patient chooses to remain in the hospital.
Who signs denial notices?
The patient or his or her legal representative signs the denial notices, and the person signing must have capacity to comprehend the form. The case manager also signs the form as the issuer of the notice. It is best for case managers to deliver notices in person so they can explain the notice and what it means.
