Knowledge Base Article

Today June 3rd is National Repeat Day. Who knew, certainly not me until doing research for this article but, today June 3rd is National Repeat Day. Although the origins of today June 3rd being National Repeat Day are not really known, it is the perfect opportunity to re-visit patient status (Inpatient or Outpatient) with a focus on communicating the status with the beneficiary. We will take a look at the Important Message from Medicare (IM) letter for the inpatient, the CMS publication “Are You a Hospital Inpatient or Outpatient?” and introduce you to a repeat piece of legislation that could impact when and how you let the Medicare beneficiary know that they are receiving services in your hospital as an Outpatient.

The Important Message from Medicare

Currently, hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare and Medicare Advantage plan enrollees) who are hospital inpatients. This letter is to be provided within two days of admission and a second copy within two days of discharge. This letter informs the beneficiary of their rights as a hospital inpatient as well as their Medicare discharge rights.

Rights as a Hospital Inpatient:

• The Right to receive Medicare covered services that include medically necessary hospital services and services that may be needed after discharge.
• The Right to know about these services, who will pay for them, and where you can get them.
• The Right to be involved in decisions about the hospital stay, and who will pay for it.
• The Right to report any concerns about the quality of care received to the Quality Improvement Organization (QIO).

Medicare Discharge Rights:

• The Right to appeal if you believe that you are being discharged too soon.
• The right to talk with hospital staff, doctor and managed care plan (if you belong to one) about your concerns.
• The right to appeal through a review of your case by a Quality Improvement Organization (QIO).

Are You a Hospital Inpatient or Outpatient?

The CMS publication 11435: “Are You a Hospital Inpatient or Outpatient?” provides information regarding the difference in patient status (inpatient or outpatient), what the difference in cost to the beneficiary will be, and common hospital situations with a description of how Medicare will pay.

The Outpatient Receiving Observation Services?

How does a beneficiary know when they are receiving care in the hospital as an Outpatient? Here at MMP we have clients that are already notifying the beneficiary when they are an Outpatient. However, if your hospital is not notifying Medicare beneficiaries of their Outpatient status, there is legislation in the U.S. House of Representatives and the U.S. Senate that could require you to develop and implement a process to do just that.

H.R. 876: Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)

Representative Lloyd Doggett (D-TX) first introduced this bill as H.R. 5232 on July 29, 2014 during the 113th Congress but it never made it to a Committee. Representative Doggett re-introduced a “repeat” version of this Bill (H.R. 876) on February 11, 2015. Unlike H.R. 5232, this bill has already made it through the House with a 395 Yea to Zero Nay vote on March 16, 2015. The two remaining steps for this Bill to become law are for it to be passed by the Senate and signed by the President (see Figure 1).

Figure 1: H.R. 876: NOTICE Act History

Bill introduced
February 11, 2015

Reported by committee
February 26, 2015 

Passed House 395-0
Marched 16, 2015

Next Step:
Passing Senate

Final step:
Enacting by President

The Congressional Research Services, which is a nonpartisan division of the Library of Congress has summarized this Act  and writes that this ACT “amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive them which:

explains the individual's status as an outpatient and not as an inpatient and the reasons why; explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility; includes appropriate additional information; is written and formatted using plain language and made available in appropriate languages; and is signed by the individual or a person acting on the individual's behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.”

S.1349: Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)

Senator Benjamin Cardin (D-MD) introduced S.1349 on May 14, 2015. This Act is also known as the NOTICE Act and is also a Bill “to amend title XVIII of the Social Security Act to require hospitals to provide certain notifications to individuals classified by such hospitals under observation status rather than admitted as inpatients of such hospitals.” Unlike H.R. 876, this bill has yet to make to a Committee (see Figure 2).

Figure 2: S.1349 NOTICE ACT History

Bill introduced
February 11, 2015

Next Step:
Reporting by Commitee 

Next Step:
Passing Senate

Next Step:
Passing House

Final step:
Enacting by President

What You Need to Know if the NOTICE Act becomes Law

• IPPS Acute and Critical Access Hospitals will be required to furnish a Notice.
• Hospitals will have 12 months after the Act becomes law to implement this process.
• A notice will need to be provided to the beneficiary no later than 36 hours after he or she begins to receive observation services (or sooner, upon release).
• The Notice will be written and formatted using plain language and made available in appropriate languages as determined by the Secretary.

For those interested in additional information about the Important Message from Medicare, the CMS publication “Are You a Hospital Inpatient or Outpatient?” or following these Bills links have been provided below. In the meantime, we will continue to follow both pieces of legislation and keep you posted on any updates.

In honor of today June 3rd being National Repeat Day I leave you with this repeatable quote.

“Decide to be a success; decide to be great, decide to be above average, decide to do the very best of you. Do you know who a P.O.O.R. person is? P.O.O.R. people are those who are “Passing On Opportunities Repeatedly."-Israelmore Ayivor, Dream Big!: See Your Bigger Picture!

Resources:

• CMS Hospital Discharge Appeal Notices web page: http://www.cms.gov/Medicare/Medicare-General-Information/BNI/HospitalDischargeAppealNotices.html
• Are You a Hospital Inpatient or Outpatient? (May 2014 version): https://www.medicare.gov/Pubs/pdf/11435.pdf
• Follow H.R. 876: NOTICE Act on govtrack.us at: https://www.govtrack.us/congress/bills/114/hr876
• Follow S. 1349: NOTICE Act on govtrack.us at: https://www.govtrack.us/congress/bills/114/s1349