The Virgin Islands HealthCare
Quality Improvement Organization
HHAs, SNFs, Hospices, and CORFs are required to provide a Generic Notice to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give beneficiaries the opportunity to request an expedited determination from a QIO. A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.
New Fast-Track Review Process for Beneficiaries in Original Medicare (Rev. 6-21-05).
Beginning July 1, 2005, beneficiaries in Original Medicare will have access to a new fast-track expedited review process when Medicare coverage of their home health, skilled nursing, comprehensive outpatient rehabilitation, or hospice services is about to end. Home health agencies, skilled nursing facilities, CORFs, and hospices (“providers”) will be required to notify individuals of this new right when they anticipate that Medicare coverage of their services will end. On April 29, 2005, the two notices associated with the implementation of these expedited reviews were published for comment in the Federal Register--the Notice of Medicare Provider Non-Coverage (Generic Notice) and the Detailed Explanation of Non-Coverage (Detailed Notice). The Office of Management and Budget approved these notices for use through 2008.
For more information, visit this site:
Fee For Service Expedited Determination Notices (FFS ED Notices)