HospitalInspections.org

Based on interview and document review, the hospital failed to provide the Important Message (IM) from Medicare in a timely manner to 4 of 4 patients (P1, P2, P3, P4) reviewed who had Medicare coverage while at the hospital.

Findings include:

P1's After Visit Summary (AVS) printed 8/17/18, indicated P1 had been admitted to the hospital on 7/12/18, and was discharged on 7/16/18. P1's Face Sheet printed 8/17/18, identified a Medicare insurance number.
P1's first CMS-R-193 (An Important Message (IM) From Medicare About Your Rights) was electronically signed on 7/12/18. P1's record lacked evidence the hospital presented a signed copy of the IM prior to discharge..

P2's AVS printed 8/17/18, indicated P2 had been admitted to the hospital on 8/1/18, and discharged on 8/15/18. P2's Face Sheet printed on 8/17/18, identified a Medicare insurance number. P2's CMS-R-193 IM form was hand signed as received on 8/8/18, seven days after admission. P2's record also lacked evidence the hospital presented a signed copy of the IM prior to discharge.

P3's AVS printed on 8/17/18, indicated P3 had been admitted to the hospital on 8/1/18 ,and discharged on 8/12/18. P3's Face Sheet printed on 8/17/18, identified a Medicare insurance number. P3's CMS-R-193 IM form was electronically signed on 8/1/18. P3's record lacked evidence the hospital presented a signed copy of the IM prior to discharge.

P4's AVS printed on 8/17/18, indicated P4 had been admitted to the hospital on 8/9/18, and discharged on 8/14/18. P4's Face Sheet printed on 8/17/18, identified a Medicare insurance number. P4's CMS-R-193 IM form was electronically signed on 8/9/18. P4's record lacked evidence the hospital presented a signed copy of the IM prior to discharge.

During an interview on 8/17/18, with registered nurses (RN)-A and RN-B informatics specialists, finance supervisor of admission and business services, and operations specialist (OS)-A, they verified P1, P2, P3,and P4's record lacked documentation a signed copy of the IM was provided prior to discharge. RN-A also confirmed R2's initial IM was not signed and dated within 48 hours of admission. The finance supervisor stated the hospital had transitioned to EPIC (electronic health record system) in May of 2018, and had started transitioning to use of electronic IMs in June of 2018. The finance supervisor also stated all IMs should have been completed electronically by July 2018, with the exception of patients in isolation and/or in the intensive care units. In addition, the finance supervisor stated not all registration staff (persons assigned to provide admission and discharge IMs) had been trained on use of the electronic format. OS-A stated the procedure was not in final draft and changes were still needed. During the course of the interview, the finance specialist and (OS)-A identified an error and/or rule in the EPIC system that would not alert registration staff (the persons responsible for providing IMs), when to provide the discharge IM to patients in the hospital.

An undated hospital procedure Medicare Admission Important Message Procedure in draft form, included instructions for obtaining a signature and documenting the Important Message (IM). The sample script for staff included: This is an important message from Medicare regarding your discharge rights. The hospital is also required to deliver the form a second time when you are preparing for dismissal. The procedure also included instructions for patients unwilling or unable to sign.