Medicare Case Review

• Important Message from Medicare (IM) and Expedited Determination Procedures for Hospital Discharges
  • Hospital Discharge Appeal Process, June 2007 (ppt file size: 2.4MB)
  • CMS' Hospital Discharge Appeal Notices - (English and Spanish versions available)
  • Notification of Hospital Discharge Appeal Rights (CMS-4105-F) FAQs
• CMS Beneficiary Notice Initiative (Web site for information about Medicare notices of noncoverage)
• CMS approved form for Appointment of Representative by Beneficiary
• CMS resource materials
• CMS Policy Manuals
• Empire Medicare Services: Local Coverage Determination (LCD)

• Appeals Contact Information

News

• 5/11/2007 - Present On Admission Indicator
  Effective October 1, 2007, Medicare will begin to accept a Present On Admission (POA) Indicator for every diagnosis on your inpatient acute care hospital claims. However, providers must submit the POA on hospital claims beginning with discharges on or after January 1, 2008. Critical access hospitals, Maryland waiver hospitals, long term care hospitals, cancer hospitals, and children's inpatient facilities are exempt from this requirement. For more information, visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5499.pdf.