A special type of appeal applies only to hospital discharges. Hospitals affected by these instructions include any facility providing care at the inpatient hospital level. Inpatient hospital care would include: short term, long term, acute or non-acute, paid through a prospective payment system or other reimbursement basis, limited to specialty care, or providing a broad spectrum of services, and acute and non-acute access hospitals. Under this heading, hospitals would also include: Indian Health Service hospitals, Medicare dependent hospitals, rehabilitation hospitals, long-term care hospitals, psychiatric hospitals, critical access hospitals, children's hospitals, and cancer hospitals. Swing beds are excluded, because they are considered a lower level of care.

Hospitals must notify Medicare members who are hospital inpatients about their hospital discharge appeal rights. Hospitals will use the CMS Form CMS-R-193 entitled Important Message from Medicare About Your Rights (IM) to explain the member’s rights as a hospital patient, including discharge appeal rights. Hospitals must issue the IM within 2 calendar days of admission, must obtain the signature of the beneficiary or his/her representative and provide a copy at that time. Hospitals should deliver this notice as far in advance as possible but no less than 2 days before discharge. If the member requests an appeal a Detailed Notice of Discharge must be issued to the member.   The IM and Detailed Notice of Discharge forms and further guidance on this ruling can be found at the following internet address: http://www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp.

You may also find a copy of the notices in the Facility – Blue Medicare PPO Supplement under the Appeals and Grievances section.