HospitalInspections.org

Based on facility policy, medical record review, and staff interview, the facility staff failed to inform Medicare beneficiaries of their hospital discharge appeal rights within two days of admission and no more than two days before discharge in 4 of 4 inpatient Medicare beneficiary patient records reviewed (Patient #3, #4, #7, #8).

The findings included:

Review of facility policy, "Important Message from Medicare and Medicare Outpatient Observation Notice" effective 06/01/2020, revealed, "...A. Important Message from Medicare: Initial Patient Notification. 1. At the time of inpatient admission, Admissions or Registration staff will give an IM (Important Message from Medicare) to all inpatients who have Medicare... The IM will be signed and dated by the patient or responsible party... D. Important Message from Medicare: Follow-up Notice 1. If the patient's length of stay is greater than 2 calendar days after the date on the original IM notice, a follow-up copy of the signed IM must be given to the patient/representative within 2 calendar days of discharge. The original notice will be signed and dated by the patient/representative in the additional information section on page 2... d. The signed and dated original notice will be filed in the patient's chart to be scanned as part of the permanent medical record..."

Request for QAPI (Quality Assessment and Performance Improvement) data related to Important Messages revealed the metric was not actively being monitored.

1. Closed medical record review of Patient #3 revealed a 67-year-old female who was admitted to the facility on 05/15/2022 at 2016 with a chief complaint of elevated blood sugar. Review of the insurance revealed Patient #3 was a Medicare beneficiary. Review of the IM revealed an unsigned and undated copy and a copy dated 05/17/2022 at 1400. Medical record review revealed Patient #3 was discharged from the facility on 05/22/2022 at 1536 to home with home health services. Medical record review failed to reveal a copy of the IM signed and dated within two days of discharge.

Interview on 06/15/2022 at 1200 with the Case Management Supervisor revealed the IMs were given to patients by the facility's representative within two days of admission and discharge. Interview revealed the IM's were given out Monday through Friday. Interview revealed the IM process had inconsistencies in form delivery and was not currently being monitored for process improvement.

2. Closed medical record review of Patient #4 revealed a 55-year-old female who was admitted to the facility on 04/06/2022 at 1926 with a chief complaint of wound infection. Review of the insurance revealed Patient #4 was a Medicare beneficiary. Review of the IM revealed an unsigned and undated copy and a copy dated 04/08/2022 at 1000. Medical record review revealed Patient #4 was discharged from the facility on 04/13/2022 at 1528 to a Skilled Nursing Facility for rehabilitation. Medical record review failed to reveal a copy of the IM signed and dated within two days of discharge.

Interview on 06/15/2022 at 1200 with the Case Management Supervisor revealed the IMs were given to patients by the facility's representative within two days of admission and discharge. Interview revealed the IM's were given out Monday through Friday. Interview revealed the IM process had inconsistencies in form delivery and was not currently being monitored for process improvement.

3. Open medical record review of Patient #7 revealed a 59-year-old male who was admitted to the facility on 06/10/2022 at 2249 with a chief complaint of altered mental status. Review of the insurance revealed Patient #7 was a Medicare beneficiary. Review of the IM revealed an unsigned and undated copy. Record review revealed an attempt to contact a patient's family member/representative on 06/13/2022 at 1100 (2 days and 12 hours after admission; 12 hours greater than policy). Medical record review failed to reveal a copy of the IM signed and dated at the time of admission.

Interview on 06/15/2022 at 1200 with the Case Management Supervisor revealed the IMs were given to patients by the facility's representative within two days of admission and discharge. Interview revealed the IM's were given out Monday through Friday. Interview revealed the IM process had inconsistencies in form delivery and was not currently being monitored for process improvement.

4. Closed medical record review of Patient #8 revealed a 61-year-old female who was admitted to the facility on 05/28/2022 at 1759 with a chief complaint of insomnia. Review of the insurance revealed Patient #8 was a Medicare beneficiary. Review revealed Patient #8 was discharged from the facility on 05/30/2022 at 1949 to her home. Medical record review failed to reveal a copy of the IM signed and dated at the time of admission or a copy of the IM signed and dated within two days of discharge.

Interview on 06/15/2022 at 1200 with the Case Management Supervisor revealed the IMs were given to patients by the facility's representative within two days of admission and discharge. Interview revealed the IM's were given out Monday through Friday. Interview revealed the IM process had inconsistencies in form delivery and was not currently being monitored for process improvement.

NC00186095