Appeals
An overview 
of this topic can be found on the CMS website.
Topics of interest include:
(clicking on a link will direct you to the CMS website. Use your browser's 'Back' button to return to our site)
FFS ED Notices for information and sample notices for Expedited Determinations (Notice of Medicare Provider Non-coverage for BIPA)
Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Hospices with beneficiaries in Fee-For-Service Medicare are required to notify beneficiaries of their right to an expedited review process when these providers anticipate that Medicare coverage of their services will end.
HHA, SNF, Hospice, CORF, and swing beds (under instruction) are required to provide a Generic Notice to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give beneficiaries the opportunity to request an expedited determination from a QIO. A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.
MA ED Notices for information and sample notices for Medicare Advantage Expedited Determinations or Notices of Medicare Noncoverage.
Under the Medicare Advantage program, HHA, SNF, CORF are required to provide a Notice of Medicare Non-coverage to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give enrollees the opportunity to request an expedited determination from a QIO. A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.
Hospital Discharge Appeals for information and sample notices regarding Hospital Discharge Appeals
Regulations
Hospitals must deliver the Important Message from Medicare to inform Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Notice is required both for Original Medicare beneficiaries and for those enrolled in Medicare health plans. Beneficiaries who choose to appeal a discharge decision will receive a more detailed notice. The rule is posted under "Downloads" along with the correction notice.
Notices
The "Important Message from Medicare" and the "Detailed Notice of Discharge" are posted along with the Manual Instructions for this process. Also posted is the Notice of Hospital Requested Review (HRR) which replaces HINN 10. The HRR should be issued by hospitals to beneficiaries in Original Medicare whenever a hospital requests QIO review of a discharge decision without physician concurrence.