HospitalInspections.org

Based in interview and document review, the hospital failed to inform patients of their rights under Medicare with the Important Message from Medicare document for 2 of 2 patients (P5, P6) reviewed who had Medicare.

Findings include:

P5 was admitted to the hospital on 11/5/20. P5's diagnoses included psychosis. A review of the patient's insurance data on 2/23/21, revealed P5 had Medicare as a payer source.

During an interview on 2/23/21, at 2:00 p.m. certified nurse specialist (CNS)-F stated she looked through the entire medical record, including scanned documents, and was unable to locate the Important Message from Medicare for P5.

P6 was admitted to the hospital on 11/10/20. P6's diagnoses included generalized anxiety disorder. A review of the patient's insurance data on 2/23/21, revealed P6 had Medicare as a payer source.

On 2/23/2021 at 2:00 p.m. CNS-F stated she looked through the entire medical record, including scanned documents, and was unable to locate the Important Message from Medicare for P6. CNS-F further stated that both patients should have received the Important Message from Medicare, and she had no idea why the message was not in the records.

The facility policy Distribution of Important Message from Medicare dated 6/6/19, directed, "All Medicare and Medicare Managed inpatients will receive the Important Message from Medicare (IM) at Admission and Discharge as required by the Center for Medicare & Medicaid Services (CMS) regulations. The IM notifies the patient of their hospital discharge appeal rights."