Any hospital, provider, Medicare Advantage plan or facility that accepts Medicare payment for services is required to provide services that are medically necessary to its patients.
The Centers for Medicare & Medicaid Services (CMS) understands that patients and health care providers may not always agree on what kind and how much care is medically necessary. In this light, CMS gives Quality Improvement Organizations, like WVMI, authority to make Medicare payment decisions when a Medicare patient disagrees with certain discharges and denials.
Our team of physician and non-physician professionals reviews the medical records of Medicare beneficiaries to determine if care:
We also maintain a roster of board-certified specialists to assess clinical care as appropriate.
To initiate a patient discharge or treatment denial, hospitals must give proper notice. CMS provides official notices, including the Hospital Issued Notice of Noncoverage, the Notice of Hospital Discharge Appeal Rights, the Important Message from Medicare and the Detailed Notice of Discharge.
To access official CMS notices such as the Hospital Discharge Appeal Notices, visit our resources page.
Powered by Kentico CMS