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Case Review | Appeals | HINNs

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Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is:

  • Not medically necessary;
  • Not delivered in the most appropriate setting; or
  • Is custodial in nature.

Please note:

  • HINN 10, also known as the Notice of Hospital Requested Review (HRR), should be issued by hospitals to beneficiaries in Original Medicare whenever a hospital requests QIO review of a discharge decision without physician concurrence.
  • HINN 11, which is used for noncovered items or services provided during an otherwise covered stay, and its instructions have not yet been incorporated into Chapter 30 of the Online Claims Processing Manual. •HINN 12 should be used in association with the Hospital Discharge Appeal Notices to inform beneficiaries of their potential liability for a noncovered continued stay.
  • The Preadmission/Admission HINN, used prior to an entirely noncovered stay, is also known as HINN 1 and replaces HINNs 1 and 9.

 

Hospital Discharge Appeal Notices

Regulations

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 2, 2007, hospitals must deliver a revised version of the Important Message from Medicare to inform Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Notice is required both for Original Medicare beneficiaries and for those enrolled in Medicare health plans. Beneficiaries who choose to appeal a discharge decision will receive a more detailed notice.The rule is posted below under "Downloads" along with the correction notice.

Notices

The latest versions of the "Important Message from Medicare", Form CMS-R-193, and the "Detailed Notice of Discharge", Form CMS-10066, - updated as of July 20, 2010 - are posted below along with the manual instructions for this process. Please note that the latest version of the "Important Message from Medicare" requires hospitals to note the time of delivery. Hospitals and Medicare Advantage organizations (MAOs) may use these versions immediately, but use is not required until April 1, 2011. After April 1, 2011, the forms with approval dates of 05/07 will not be valid.

 

For more information, visit:

Fee For Service Hospital-Issued Notice of Noncoverage (FFS HINNs)