HospitalInspections.org

Based on review of medical records, staff interview and review of facility policy and procedure it was determined the facility failed to ensure each patient, Medicare beneficiaries, or patient's representative was informed of their hospital discharge appeal rights for two (#4, #5) of three Medicare beneficiaries, of ten patients sampled.

Findings included:

The facility policy and procedure, "Important message from Medicare (IMM) - Distribution of Follow-Up Hospital Discharge Appeal Notice," issued 9/2013, was reviewed. The policy stated all Medicare and Medicare Advantage HMO beneficiaries, who receive a hospital inpatient level of care, must be provided with the IMM for each hospital admission. This statutorily required notice explains beneficiaries' rights as hospital patients and their discharge appeal rights. For each inpatient admission, the initial IMM must be issued within two (2) calendar days and the Follow-Up IMM must be delivered not more than two (2) calendar days before discharge.

Review of the medical record for patient #4 revealed the patient was admitted as an inpatient on 2/16/2016. Documentation revealed the patient was a Medicare beneficiary. Review of the record revealed the IMM was signed by the patient's representative on 2/17/2016 at 2:50 p.m. The patient was discharged from the facility on 2/26/2016. Review of the record revealed no evidence the patient or patient's representative was provided a Follow-Up IMM prior to discharge.

Review of the medical record for patient #5 revealed the patient was admitted as an inpatient on 2/12/2016. Documentation revealed the patient was a Medicare beneficiary. Review of the record revealed no evidence the patient or patient's representative was provided an initial IMM within two calendar days of admission. The patient was discharged from the facility on 2/17/2016. Review of the record revealed no evidence the patient or patient's representative was provided a Follow-Up IMM prior to discharge.

Interview with the risk manager on 4/01/2016 at approximately 5:40 p.m., confirmed the above findings.