Benefits Improvement and Protection Act (BIPA) Reviews The Benefits Improvement and Protection Act gives Medicare beneficiaries the right to appeal any time a provider terminates care due to lack of medical necessity.

Benefits Improvement and Protection Act notices can be found on the Beneficiary Notices Initiative page with the FF ED Notices. For more information, review the Fee for Service Expedited Determination (ED) Process PDF which includes questions and answers that pertain to beneficiaries who have Original Medicare. These appeals are similar to the ones for beneficiaries enrolled in a Medicare Advantage Plan.

Before providers terminate services, they need to give beneficiaries a written notice that care involving a skilled nursing facility, home health agency, comprehensible outpatient rehabilitation facility or hospice will be discontinued. Beneficiaries need to receive the notice two or more days before covered services are supposed to end.

If the beneficiary wants to appeal to WVMI, the provider needs to give the beneficiary a detailed notice listing the reasons why services are no longer covered. WVMI will need a copy of the beneficiary’s medical record, the initial notice and the detailed notice.


Learn More About BIPAWVMI offered BIPA training to providers in 2005. Recordings of these training sessions are available. The materials below were used for the BIPA training sessions.

Please send us your BIPA contact information. After completing the PDF form, fax it to 304-342-5527, attention Libby Akers.




 
ED Q&As ED Questions and Answers available on CMS' Web site.