HospitalInspections.org

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined the facility failed to provide Medicare beneficiaries with the "Important Message from Medicare" form for three of five records reviewed (MR1, MR2, and MR3).

Findings include:

Review on April 10, 2012, of the facility policy "Important Message From Medicare," dated November 18, 2012, revealed "Policy: It is the policy of Mercy Suburban Hospital ... to provide any Medicare Fee for Service/Medicare Managed Care (HMO) inpatients their right to the Important Message from Medicare (IMM) appeal guidelines ... The admitting registrar will provide the IMM to all eligible Medicare and Medicare HMO recipients and obtain a signature from the patient or next of kin (NOK) ... Case Management: The yellow IMM notice will be given to the patient by Case Management no more than 2 days prior to discharge when the length of stay exceeds two days. Patient must sign the original (white) copy as proof of receipt of the second notice."

Review of MR1 revealed the patient was admitted on March 7, 2012, and was discharged March 16, 2012. Further review of MR1 revealed no documented evidence the patient was given or notified of the "An Important Message From Medicare About Your Rights" form prior to discharge from the facility.

Review of MR2 revealed the patient was admitted on March 15, 2012, and was discharged March 22, 2012. Further review of MR2 revealed no documented evidence the patient was given or notified of the "An Important Message From Medicare About Your Rights" form at or within two days of admission to the facility and prior to discharge from the facility.

Review of MR3 revealed the patient was admitted on March 12, 2012, and was discharged March 21, 2012. Further review of MR3 revealed no documented evidence the patient was given or notified of the "An Important Message From Medicare About Your Rights" form at or within two days of admission to the facility.

Interview with EMP2 on April 10, 2012, confirmed there was no documented evidence in MR1 that this patient received a copy of the "An Important Message From Medicare About Your Rights" form prior to discharge from the facility. EMP2 confirmed there was no documented evidence in MR2 the patient was given or notified of the "An Important Message From Medicare About Your Rights" form at or within two days of admission to the facility and prior to discharge from the facility. EMP2 confirmed there was no documented evidence in MR3 the patient was given or notified of the "An Important Message From Medicare About Your Rights" form at or within two days of admission to the facility.