Administrative Memos

200705

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jun 11, 2007
SUBJECT: IPRO Review Of The New Hospital Discharge Appeals For The Medicare Beneficiary-Effective July 2, 2007 - Important Telephone Number Information
IPRO CONTACTS:

Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, extension 423; Fran Gordon, Assistant Director, Medicare/Federal Health Care Assessment, extension 423

As you may already be aware, effective Monday, July 2, 2007, IPRO, the Quality Improvement Organization (QIO) for New York, will begin to review Medicare Fee-for-Service (FFS) beneficiary as well as Medicare Advantage (MA) Plan enrollee requests for expedited appeals, should they disagree with their proposed hospital discharge . This new appeal process is being established in accordance with the Centers for Medicare & Medicaid Services (CMS) final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights published on November 27, 2006. (For further information, please refer to CMS-4105-F Notification of Hospital Discharge Appeal Rights Final Rule PDF, 174 KB)

Accordingly, CMS has indicated that beginning July 2, 2007, hospitals must deliver a revised version of the Important Message from Medicare (IMM) to inform Medicare beneficiaries and Medicare Advantage Plan enrollees who are hospital inpatients about their hospital discharge appeal rights. The notice is required both for Original Medicare beneficiaries and for those enrolled in Medicare health plans.

The purpose of this memorandum is to provide you with the IPRO telephone numbers that should be inserted in the revised Important Message from Medicare (IMM) in regard to the Quality Improvement Organization (QIO) review.

On Page 1, Bullet #3 of the revised IMM... "concerns you have about the quality of care," please insert the following information:

IPRO

1-800-331-7767

TTY: 1-866-446-3507 or 516-326-6182

On Page 2, first sub-bullet of the revised IMM..." Steps to Appeal Your Discharge", please insert the following information:

IPRO

1-800-446-2447

TTY: 1-866-446-3507 or 516-326-6182

Should you have any questions or require additional information, please do not hesitate to contact Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, 516-326-7767, extension 423 or Fran Gordon, Assistant Director, Medicare/Federal Health Care Assessment, extension 423.