HospitalInspections.org

Based on policy and procedure review, clinical record review and interview, it was determined, of the 11 clinical records reviewed, 7 were Medicare beneficiary patients. The facility failed to ensure four (#1, #6, #9 and #11) of seven (#1, #2, #6, #7, #9, #10 and #11) Medicare beneficiary patients were provided "An Important Message from Medicare" within two days of admission and/or within 48 hours of discharge from the facility. The failed practice did not ensure Medicare beneficiary patients were informed of their Medicare rights and had the potential to affect all Medicare beneficiary patients seen in the facility. The findings follow:

A. Review of Patient #1's clinical record revealed there was no evidence the patient received "An Important Message from Medicare" document within 48 hours of discharge from the facility. The findings were confirmed in a telephone interview with the Chief Operations Officer on 07/25/11 at 1149.
B. Review of Patient #6's clinical record revealed the "An Important Message from Medicare" document was present in the clinical record, but the patient had not signed the document to indicate the patient had received the information. The findings were confirmed in an interview with Quality Management Project Manager on 07/19/11 at 0940.
C. Review of Patient #9's clinical record revealed the "An Important Message from Medicare" document was present in the clinical record, but the patient had not signed the document to indicate the patient had received the information. The findings were confirmed in an interview with Clinical Manager of 4C on 07/19/11 at 1105.
D. Review of Patient #11's clinical record revealed there was no evidence the patient received the "An Important Message from Medicare" document within two days of admission and did not received the "An Important Message from Medicare" document within 48 hours of discharge from the facility. The findings were confirmed in a telephone interview with the Chief Operations Officer on 07/25/11 at 1149.
E. Review of the policy "Medicare Discharge Appeal Rights Notification Process" on 07/19/11 revealed, "Per CMS (Centers for Medicare and Medicaid Services), Hospitals must issue the IM (Important Message) within two calendar days of the day of admission and obtain the signature of the beneficiary or his or her representative to indicate that he or she received and understood the notice. Per CMS, the IM must also be provided to each beneficiary with(in) two calendar days of the day of discharge."