HospitalInspections.org

Based on interview and document review, the hospital failed to provide An Important Message from Medicare (IM) notice within two days of admission for 2 of 18 Medicare beneficiary inpatient patients (P1, P17). This had the potential to impact all Medicare beneficiaries admitted to the hospital.

Findings include:

The CMS Beneficiary Notices Initiative (BNI) website, dated 12/3/24, directed hospitals were "required to deliver the [IM notice] ...CMS-10065 to all Medicare beneficiaries ..." who were hospital inpatients. This notice informed patients of their hospital discharge appeal rights. CMS-10065 notice instructions, located in the Medicare Claims Processing Manual - Chapter 30, dated 8/1/24, section 200.3.3 - Hospital Delivery of the IM, directed the hospital "must ensure that the beneficiary or representative signs and dates the IM to demonstrate that the beneficiary or representative received the notice and understands its contents." The section 200.3.4 - Required Delivery Timeframes, directed the hospital to deliver an initial copy of the IM "at or near admission, but no later than 2 (two) calendar days following the date of the beneficiary's admission to the hospital." In addition, the section identified a follow-up IM was to be delivered "Two days before discharge" and no later than four hours prior to discharge. The section lacked identification for issuance exceptions.

On 2/25/25, during the abbreviated medical record review process, the following information was identified:

-P1 admitted on 2/16/25, and was currently admitted. P1's insurance was identified as Medicare. The Emergency Contact section identified a cousin as the emergency contact. P1's record identified a refusal to sign dated 2/24/25, eight days after admission. Registered nurse (RN)-A verified the IM was not provided to P1 within two days of admission and did not know why it was not provided until 2/24/25.

On 2/27/25, during the abbreviated medical record review process, the following information was identified:

-P17 admitted 2/21/25, and was currently admitted. P17's insurance was identified as Medicare. The Emergency Contact section identified a friend as the emergency contact. P17's record identified P17 signed the IM on 2/26/25, five days after admission. RN-B verified the IM was not provided within two days of admission.

On 2/27/25 at 3:35 p.m., case management director verified the IM should be provided to the patient within the first two days of admission so they would have the opportunity to appeal decisions.

A policy on providing IM to patients was requested but not provided.