HospitalInspections.org

Based on interview and document review, the hospital failed to provide the Important Message from Medicare (IM) within two days of admission, or two calendar days prior to discharge for 2 of 10 patients (P3, P6) reviewed who had Medicare coverage while at the hospital.

Findings include:

The CMS Beneficiary Notices Initiative (BNI) website dated 9/6/23, directed hospitals were "required to deliver the [IM form], formerly CMS-R-193 and now CMS-10065 to all Medicare beneficiaries ..." who were hospital inpatients. "The new versions must be used no later than April 27, 2023." This form informed patients of their hospital discharge appeal rights. CMS-10065 form instructions directed the facility to insert the name and toll-free number of the QIO for the state where the hospital was located.

The CMS QIO website dated 9/6/23, identified Minnesota's QIO was Livanta and provided the phone number.

P3's medical record lacked an Important Message from Medicare (IM) message which is required to be given two calendar days prior to discharge provided signed and dated CMS-10065, or documentation to support attempt(s) to provide the notice.

P6's medical record lacked an Important Message from Medicare (IM) message which is required to be given two calendar days prior to discharge provided signed and dated CMS-10065, or documentation to support attempt(s) to provide the notice.

On 10/30/24 at approximately 10:50 a.m., registered nurse (RN)-A identified P3 and P6 were Medicare beneficiaries. RN-A verified P3 and P6 did not received the IM message related to anticipated discharge. RN-A stated it was the responsibility of the RN Director or Case Manager to provide the IM to those patients with Medicare Benefits.

On 10/30/24 at approximately 10:54 a.m., risk/compliance specialist (RCS) verified P3 and P6 had not received the IM message related to anticipated discharge. In addition, she identified the facility was not providing any patients who had Medicare coverage the required IM message related to anticipated discharge.

A list of patients discharged since 8/30/24, was requested along with payer source identification and evidence the IM was provided upon discharge for any Medicare beneficiaries discharged within this time frame. The facility identified a total of 48 discharged patients were Medicare beneficiaries, and all of which were required to receive the IM related to anticipated discharge. However, none of the 48 Medicare beneficiaries received the IM related to discharge planning.

A Social Services/Case Management policy dated 11/17/23, identified a purpose to ensure all Medicare patients are given and understand their Medicare rights related to the inpatient hospital stay. The policy provided guidance which included the patient or representative will receive another copy of the "Important Message" from Medicare not more than 2 calendar days before discharge.