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We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

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red emblem to indicate important information update - hospital discharge appeal notices

Attention: This update is to share an important announcement from the Centers for Medicare & Medicaid Services (CMS) because it will affect the daily work of acute care providers.

The Centers for Medicare & Medicaid Services (CMS) made changes to the Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) forms and required providers to begin using the new forms by April 1, 2020. The forms, both English and Spanish versions, along with detailed information are available on the Hospital Discharge Appeal Notices page of CMS’ website.

Providers should direct all questions regarding these forms to CMS by completing and submitting this online form.

red emblem to indicate important information  covid-19 updates

  • Kepro is doing everything possible to minimize the spread of the illness and protect our staff. At this time, Kepro employees are working remotely away from our offices. To help avoid any delays with cases, we are asking providers to please submit all medical records electronically by faxing instead of mailing copies of paper records.
  • Information from CMS:
    • CMS Fact Sheet with waiver information, including guidance on the three-day hospital stay prior to admission to a skilled nursing facility
    • CMS guidance on the delivery of beneficiary notices

hospital discharge appeals

On November 27, 2006, the Centers for Medicare & Medicaid Services (CMS) published a final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights. Beginning July 1, 2007, hospitals must deliver the Important Message from Medicare (IM) to inform all Medicare inpatients, including Medicare Advantage enrollees, Medicare as a Secondary Payor (MSP), and dual-eligible patients about their hospital discharge appeal rights.

Hospitals are required to give a Detailed Notice of Discharge (DND) to patients who choose to appeal a discharge decision. The DND outlines the specific reasons for discharge and applicable Medicare coverage guidelines.

Hospital Requested Review (HRR)
HINN 10, also known as the Notice of Hospital Requested Review (HRR), should be issued by hospitals to patients with Original Medicare whenever a hospital requests a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) review of a discharge decision without physician concurrence. To initiate an HRR, the hospital staff should call Kepro, and then electronically send the medical record. HRRs are completed Monday - Friday and will be completed within two business days of the receipt of all pertinent information requested.

expedited determinations

Home health agencies (HHAs), skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), and hospices with patients that have Medicare are required to notify them of their right to an expedited review process when these providers anticipate that Medicare coverage of their services will end.

HHAs, SNFs, hospices, CORFs, and swing beds (under instruction) are required to provide a Notice of Medicare Non-Coverage to Medicare patients (including those patients with a Medicare Advantage plan) to alert them that a Medicare-covered item or service is ending and give patients the opportunity to request an expedited determination from a BFCC-QIO. A Detailed Notice is given when the BFCC-QIO review is requested in order to provide more explanation on why coverage is ending.

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contact information

Telephone, Fax Numbers and Mailing Addresses
Region 1
Connecticut
Massachusetts
Maine
New Hampshire
Rhode Island
Vermont
Region 4
Alabama
Florida
Georgia
Kentucky
Mississippi
North Carolina
South Carolina
Tennessee
Region 6
Arkansas
Louisiana
New Mexico
Oklahoma
Texas
Region 8
Colorado
Montana
North Dakota
South Dakota
Utah
Wyoming
Region 10
Alaska
Idaho
Oregon
Washington
Toll-free Phone
888-319-8452

Local Phone
216-447-9604

TTY*
855-843-4776

Toll-free Fax**

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131
Toll-free Phone
888-317-0751

Local Phone
813-280-8256

TTY*
855-843-4776

Toll-free Fax**

Mailing Address
5201 West Kennedy Blvd.
Suite 900
Tampa, FL 33609
Toll-free Phone
888-315-0636

Local Phone
813-280-8256

TTY*
855-843-4776

Toll-free Fax**

Mailing Address
5201 West Kennedy Blvd.
Suite 900
Tampa, FL 33609
Toll-free Phone
888-317-0891

Local Phone
216-447-9604

TTY*
855-843-4776

Toll-free Fax**

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131
Toll-free Phone
888-305-6759

Local Phone
216-447-9604

TTY*
855-843-4776

Toll-free Fax**

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131

*A TTY (teletypewriter) is a special device that lets people who are deaf, hard of hearing, or speech-impaired use the telephone to communicate, by allowing them to type messages back and forth to one another instead of talking and listening. A TTY is required at both ends of the conversation in order to communicate.

**Healthcare providers: Please fax medical records to the fax number specified on the medical record request, which may be different than the number above.

 




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