Medicare will only reimburse hospitals for medically necessary care, but Medicare has established a way for hospitals to bill beneficiaries who want to stay in the hospital regardless of medical necessity. In order for the beneficiary to be billed, hospitals must give proper notice. Proper notice comes in the form of Hospital Issued Notices of Noncoverage (HINNs) and Notices of Hospital Discharge Appeal Rights. Hospitals issue the notices of noncoverage when the provider believes there’s no medical reason to admit a Medicare beneficiary. If the beneficiary wants to stay in the hospital, the hospital gives them an Important Message (IM) and a Detailed Notice of Discharge.
WVMI will review the Hospital Issue Notices of Noncoverage and the Important Message appeals to make sure they follow Medicare policy. WVMI will decide whether a beneficiary can be admitted to the hospital. WVMI will reconsider the decision upon the beneficiary’s request.
Download the Hospital Issued Notices PowerPoint to learn more.
For assistance or resources, please call Cathy Browning toll-free at 1.800.642.8686, ext. 4256 or at 304.346.9864, ext. 4256 or e-mail her at cbrowning@wvmi.org.
HINN/IM Review