Don't let the IM fall through the cracks

CMS: Still notify patients of discharge rights

Hospitals still need to be vigilant about issuing the Important Message from Medicare (IM), notifying Medicare patients of their right to appeal their discharge, their financial responsibilities, and how to appeal their discharge, warns Jackie Birmingham, RN, MS, CMAC.

"When I speak to case managers and discharge planners, I am getting questions that indicate that some hospitals may be slacking off in issuing the IM. There seems to be a rumor that Medicare isn't paying attention to compliance with the IM regulations. This is not the case," adds Birmingham, vice president of professional services for Curaspan Health Group, a Newton, MA, health care technology and services firm.

The Centers for Medicare & Medicaid Services (CMS) issued a revised "Interpretive Guidelines" in October 2008 that is to be used by surveyors when they visit the hospital to determine if the Conditions of Participation are being followed.

"Hospitals must establish and implement policies and procedures that effectively ensure that patients and/or their representatives have the information necessary to implement their rights," the Interpretive Guidelines for the Conditions of Participation state.

To whom does the IM apply?

The rule applies to traditional Medicare beneficiaries, beneficiaries enrolled in Medicare Advantage programs, and other Medicare health plans that are subject to Medicare regulations.

The Important Message from Medicare must be delivered within two calendar days of inpatient admission and must be signed by the beneficiary or his or her representative and dated, and a copy must be given to them.

If a patient stays more than two days in the hospital, he or she must receive a copy of the original signed form within two calendar days of discharge.

CMS allows hospitals to issue the IM at preadmission, but not more than seven calendar days before the admission.

"The second copy still needs to be given. It doesn't have to be signed by the patient, but the hospital still has to prove that it's been given, so signing is still a good idea," Birmingham says.

According to the survey procedures issued by CMS, the surveyors will determine the hospital's policy for notifying patients of their rights and determine that the information provided to the patients complies with federal and state law. They will review the records and interview staff to determine how the hospital communicates information about their rights to diverse patients and whether they use alternative means such as signs and interpreters to communicate patient rights.

(Editor's note: For more information, see: